Surgical Endoscopy

, Volume 23, Issue 3, pp 496–502

Laparoscopic and open reversal of Hartmann’s procedure—a comparative retrospective analysis

  • Haggi Mazeh
  • Alexander J. Greenstein
  • Kristin Swedish
  • Scott Q. Nguyen
  • Aaron Lipskar
  • Kaare J. Weber
  • Edward H. Chin
  • Celia M. Divino



Restoration of intestinal continuity after Hartmann’s procedure has traditionally required laparotomy. This study compares our experience with laparoscopic and open reversal of Hartmann’s procedure.

Study design

All laparoscopic and open Hartmann’s reversal procedures performed between January 1998 and June 2006 were reviewed. Patients with laparoscopic reversal were retrospectively matched by age, body mass index (BMI), and indication to controls with open reversal. Demographic data, perioperative course, and postoperative complications were documented.


We identified 41 patients who underwent laparoscopic reversal of Hartmann’s procedure and these were matched to 41 patients with open reversal. The groups had similar average age and BMI. The predominant indication for surgery in both groups was diverticular disease. Conversion to laparotomy occurred in eight patients (19.5%), and was due to dense adhesions or difficulty in identification of the rectal stump. Adhesions were significantly greater in the conversion group (p <0.05), and the rectal stump was not marked in any of these cases. The most common short-term complications were ileus and surgical site infection. There were no anastomotic leaks and no mortalities. The mean operative times in the laparoscopic and open groups were 193 versus 209 min, respectively (p = 0.33). The laparoscopic group had a significantly lower estimated blood loss of 166 versus 326 mL (p < 0.0005), shorter time to bowel function return (4.1 versus 5.2 days, p < 0.05), and a shorter hospital stay (6.4 versus 8.0 days, p < 0.05). The major complication rate was also significantly lower in the laparoscopic group than in the open group (4.8% versus 12.1%, p < 0.05).


Laparoscopic reversal of Hartmann’s procedure is a safe and practical alternative to open reversal. It can be performed with similar operative time, fewer complications, and a faster recovery time. Conversion during the reversal procedure was significantly impacted by severity of adhesions and marking of the rectal stump.

Key words

Hartmann’s procedure Reversal Laparoscopy Colostomy closure 



body mass index


laparoscopic-assisted Hartmann’s reversal


open Hartmann’s reversal


patient-controlled analgesia


surgical intensive care unit


  1. 1.
    Hartmann H (1923) Note sur un procédé nouveau d'extirpation des cancers de la partie du côlon. Bull Mem Soc Chir Paris 49:1474–1477Google Scholar
  2. 2.
    Desai DC, Brennan EJ, Reilly JF, Smink RD (1998) Utility of the Hartmann procedure. Am J Surg 175:152–154PubMedCrossRefGoogle Scholar
  3. 3.
    Demetriades D, Pezikis A, Melissas J, Parekh D, Pickles G (1988) Factors influencing the morbidity of colostomy closure. Am J Surg 155:594–596PubMedCrossRefGoogle Scholar
  4. 4.
    Schilling MK, Maurer CA, Kollmar O, Buchler MW (2001) Primary vs. secondary anastomosis after sigmoid colon resection for perforated diverticulitis (Hinchey stage III and IV): a prospective outcome and cost analysis. Dis Colon Rectum 44:699–703PubMedCrossRefGoogle Scholar
  5. 5.
    Ghorra SG, Rzeczycki TP, Natarajan R, Pricolo VE (1999) Colostomy closure: impact of preoperative risk factors on morbidity. Am Surg 65:266–269PubMedGoogle Scholar
  6. 6.
    Braga M, Vignali A, Gianotti L, Zuliani W, Radaelli G, Gruarin P, Dellabona P, Di Carlo V (2002) Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome. Ann Surg 236:759–766PubMedCrossRefGoogle Scholar
  7. 7.
    Degiuli M, Mineccia M, Bertone A, Arrigoni A, Pennazio M, Spandre M, Cavallero M, Calvo F (2004) Outcome of laparoscopic colorectal resection. Surg Endosc 18:427–432PubMedCrossRefGoogle Scholar
  8. 8.
    Braga M, Frasson M, Vignali A, Zuliani W, Civelli V, Di Carlo V (2005) Laparoscopic vs. open colectomy in cancer patients: long-term complications, quality of life, and survival. Dis Colon Rectum 48:2217–2223PubMedCrossRefGoogle Scholar
  9. 9.
    Alves A, Panis Y, Slim K, Heyd B, Kwiatkowski F, Mantion G, Association Française de Chirurgie (2005) French multicentre prospective observational study of laparoscopic versus open colectomy for sigmoid diverticular disease. Br J Surg 92:1520–1525PubMedCrossRefGoogle Scholar
  10. 10.
    Schwenk W, Haase O, Neudecker J, Muller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 3:CD003145Google Scholar
  11. 11.
    Anderson CA, Fowler DL, White S, Wintz N (1993) Laparoscopic colostomy closure. Surg Laparosc Endosc 3:69–72PubMedGoogle Scholar
  12. 12.
    Gorey TF, O’Connell PR, Waldron D, Cronin K, Kerin M, Fitzpatrick JM (1993) Laparoscopically assisted reversal of Hartmann’s procedure. Br J Surg 80:109PubMedCrossRefGoogle Scholar
  13. 13.
    Costantino GN, Mukalian GG (1994) Laparoscopic reversal of Hartmann procedure. J Laparoendosc Surg 4:429–433PubMedGoogle Scholar
  14. 14.
    Rosen MJ, Cobb WS, Kercher KW, Heniford BT (2006) Laparoscopic versus open colostomy reversal: a comparative analysis. J Gastrointest Surg 10:895–900PubMedCrossRefGoogle Scholar
  15. 15.
    Roe AM, Prabhu S, Ali A, Brown C, Brodribb AJ (1991) Reversal of Hartmann’s procedure: timing and operative technique. Br J Surg 78:1167–1170PubMedCrossRefGoogle Scholar
  16. 16.
    Keck JO, Collopy BT, Ryan PJ, Fink R, Mackay JR, Woods RJ (1994) Reversal of Hartmann’s procedure: effect of timing and technique on ease and safety. Dis Colon Rectum 37:243–248PubMedCrossRefGoogle Scholar
  17. 17.
    Khosraviani K, Campbell WJ, Parks TG, Irwin ST (2000) Hartmann procedure revisited. Eur J Surg 166:878–881PubMedCrossRefGoogle Scholar
  18. 18.
    Livingston DH, Miller FB, Richardson JD (1989) Are the risks after colostomy closure exaggerated? Am J Surg 158:17–20PubMedCrossRefGoogle Scholar
  19. 19.
    Mosdell DM, Doberneck RC (1991) Morbidity and mortality of ostomy closure. Am J Surg 162:633–636PubMedCrossRefGoogle Scholar
  20. 20.
    Hasukic S, Mesic D, Dizdarevic E, Keser D, Hadziselimovic S, Bazardzanovic M (2002) Pulmonary function after laparoscopic and open cholecystectomy. Surg Endosc 16:163–165PubMedCrossRefGoogle Scholar
  21. 21.
    Hendolin HI, Paakonen ME, Alhava EM, Tarvainen R, Kemppinen T, Lahtinen P (2000) Laparoscopic or open cholecystectomy: a prospective randomised trial to compare postoperative pain, pulmonary function, and stress response. Eur J Surg 166:394–399PubMedCrossRefGoogle Scholar
  22. 22.
    Sosa JL, Sleeman D, Puente I, McKenney MG, Hartmann R (1994) Laparoscopic-assisted colostomy closure after Hartmann’s procedure. Dis Colon Rectum 37:149–152PubMedCrossRefGoogle Scholar
  23. 23.
    Regadas FS, Siebra JA, Rodrigues LV, Nicodemo AM, Reis Neto JA (1998) Complications in laparoscopic colorectal resection: main types and prevention. Surg Laparosc Endosc 8:189–192PubMedCrossRefGoogle Scholar
  24. 24.
    Vacher C, Zaghloul R, Borie F, Laporte S, Callafe R, Skawinski P, Leynau G, Domergue J (2002) Laparoscopic re-establishment of digestive continuity following Hartmann’s procedure. Retrospective study of the French Society of Endoscopic Surgery] Ann Chir 127:189–192Google Scholar
  25. 25.
    Khaikin M, Zmora O, Rosin D, Bar-Zakai B, Goldes Y, Shabtai M, Ayalon A, Munz Y (2006) Laparoscopically assisted reversal of Hartmann’s procedure. Surg Endosc 20(12):1883–1886PubMedCrossRefGoogle Scholar
  26. 26.
    Beck DE, Cohen Z, Fleshman JW, Kaufman HS, van Goor H, Wolff BG (2003) Adhesion Study Group Steering Committee. A prospective, randomized, multicenter, controlled study of the safety of Seprafilm adhesion barrier in abdominopelvic surgery of the intestine. Dis Colon Rectum 46:1310–1319PubMedCrossRefGoogle Scholar
  27. 27.
    Fazio VW, Cohen Z, Fleshman JW, van Goor H, Bauer JJ, Wolff BG, Corman M, Beart RW Jr, Wexner SD, Becker JM, Monson JR, Kaufman HS, Beck DE, Bailey HR, Ludwig KA, Stamos MJ, Darzi A, Bleday R, Dorazio R, Madoff RD, Smith LE, Gearhart S, Lillemoe K, Gohl J (2006) Reduction in adhesive small-bowel obstruction by Seprafilm adhesion barrier after intestinal resection. Dis Colon Rectum 49:1–11PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Haggi Mazeh
    • 1
  • Alexander J. Greenstein
    • 2
  • Kristin Swedish
    • 2
  • Scott Q. Nguyen
    • 2
  • Aaron Lipskar
    • 2
  • Kaare J. Weber
    • 2
  • Edward H. Chin
    • 2
  • Celia M. Divino
    • 2
  1. 1.Department of General SurgeryHadassah-Hebrew University Medical CenterJerusalemIsrael
  2. 2.Department of SurgeryMount Sinai School of MedicineNew YorkUSA

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