Surgical Endoscopy

, Volume 30, Issue 6, pp 2628–2631 | Cite as

Transanal Hartmann reversal: a new technique

  • R. BravoEmail author
  • M. Fernández-Hevia
  • M. Jiménez-Toscano
  • L. F. Flores
  • B. de Lacy
  • S. Quaresima
  • A. M. Lacy
New Technology



Hartmann procedure consists in a sigmoidectomy followed by a terminal colostomy. However, the stoma is associated with complications and suboptimal quality of life, so the restoration of colonic continuity should be, at least, considered in any case. Open restoration has been associated with significant morbidity and mortality; therefore, many authors have described the advantages of laparoscopic Hartmann reversal. We want to go a step further showing our experience using a combined laparoscopic and transanal approach in an attempt to improve the surgical technique.


Patients with an end colostomy due to an emergency Hartmann procedure are selected for this intervention. This approach is performed simultaneously laparoscopically and transanally, with single-port devices, through the colostomy wound in the first case and trough anal canal in the second one. The previous stapler line is resected transanally and the proximal rectum and mesorectum are dissected until the peritoneal reflexion, where both teams work together to complete the adhesiolysis. Finally an end-to-end anastomosis is performed under laparoscopic control.


As in patients with rectal cancer, dissection of the stump in Hartmann reversal procedure may be better and associated with shorter operative time.


As with any new surgical procedure, it is probably too early to draw conclusions, but nowadays transanal combined with laparoscopic approach seems to be a safe and feasible technique to perform a Hartmann reversal.


TAMIS Hartmann reversal Trasanal total mesorectal excision Rectal cancer 


Compliance with ethical standards


Authors R. Bravo, M. Fernández-Hevia, M. Jiménez-Toscano, L. F. Flores, B. de Lacy, S. Quaresima and A.M. Lacy have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (MP4 319709 kb)


  1. 1.
    van de Wall BJ, Draaisma WA, Schouten ES, Broeders IA, Consten EC (2010) Conventional and laparoscopic reversal of the Hartmann procedure: a review of literature. J Gastrointest Surg 14:743–752CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Maggard MA, Aingmond D, O’Connell JB, Ko CY (2004) What proportion of patients with an ostomy (for diverticulitis) get reversed? Am Surg 70:928–931PubMedGoogle Scholar
  3. 3.
    Carus Th, Emmert A (2011) Single-port laparoscopic reversal of Hartmann’s procedure: technique and results. Minimal Invasiv Surg. doi: 10.1155/2011/356784 Google Scholar
  4. 4.
    Holland JC, Winter DC, Richardson D (2002) Laparoscopically assisted reversal of Hartmann’s procedure revisited. Surg Laparosc Endosc Percutan Tech 12(4):291–294CrossRefPubMedGoogle Scholar
  5. 5.
    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 20:1883–1886CrossRefPubMedGoogle Scholar
  6. 6.
    Riansuwan W, Hull TL, Millan MM, Hammel JP (2009) Non-reversal of Hartmann’s procedure for diverticulitis: derivation of a scoring system to predict nonreversal. Dis Colon Rectum 52(8):1400–1408CrossRefPubMedGoogle Scholar
  7. 7.
    Banerjee S, Leather AJ, Rennie JA, Samano N, Gonzalez JG, Papagrigoriadis S (2005) Feasibility and morbidity of reversal of Hartmann’s. Colorectal Dis 7(5):454–459CrossRefPubMedGoogle Scholar
  8. 8.
    Fucini C, Gattai R, Urena C, Bandettini L, Elbetti C (2008) Quality of life among five-year survivors after treatment for very low rectal cancer with or without a permanent abdominal stoma. Ann Surg Oncol 15:1099–1106CrossRefPubMedGoogle Scholar
  9. 9.
    Vermeulen J, Gosselink MP, Busschbach JJ, Lange JF (2010) Avoiding or reversing Hartmann’s procedure provides improved quality of life after perforated diverticulitis. J Gastrointest Surg 14(4):651–657CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Gorey TF, O’Connell PR, Waldron D, Cronin K, Kerin M, Fitzpatrick JM (1993) Laparoscopically assisted colostomy closure after Hartmann’s procedure. Br J Surg 80:109CrossRefPubMedGoogle Scholar
  11. 11.
    Bozzetti F, Nava M, Bufalino R, Menotti V, Marolda R, Doci R, Gennari L (1983) Early local complications following colostomy closure in cancer patients. Dis Colon Rectum 26:25–29CrossRefPubMedGoogle Scholar
  12. 12.
    Ghorra SG, Rzeczycki TP, Natarajan R, Pricolo VE (1999) Colostomy closure: impact of preoperative risk factors on morbidity. Am Surg 65:266–269PubMedGoogle Scholar
  13. 13.
    Siddiqui MRS, Sajid MS, Baig MK (2010) Open vs laparoscopic approach for reversal of Hartmann´s procedure: a systematic review. Colorectal Dis 12:733–741CrossRefPubMedGoogle Scholar
  14. 14.
    Arkenbosch J, Miyagaki H, Shantha Kumara HM, Yan X, Cekic V, Whelan RL (2015) Efficacy of laparoscopic-assisted approach for reversal of Hartmann’s procedure: results from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Surg Endosc 29(8):2109–2114CrossRefPubMedGoogle Scholar
  15. 15.
    Fernández-Hevia M, Delgado S, Castells A, Tasende M, Momblan D, del Gobbo GD, de Lacy B, Balust J, Lacy AM (2015) Transanal total mesorectal excision in rectal cancer: short-term outcomes in comparison with laparoscopic surgery. Ann Surg 261(2):221–227CrossRefPubMedGoogle Scholar
  16. 16.
    Velthuis S, Veltcamp Helbach M, Tuynman JB, Le TN, Bonjer HJ, Sietses C (2015) Intra-abdominal bacterial contamination in TAMIS total mesorectal excision for rectal carcinoma: a prospective study. Surg Endosc. doi: 10.1007/s00464-015-4089-x Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • R. Bravo
    • 1
    Email author
  • M. Fernández-Hevia
    • 1
  • M. Jiménez-Toscano
    • 1
  • L. F. Flores
    • 1
  • B. de Lacy
    • 1
  • S. Quaresima
    • 1
  • A. M. Lacy
    • 1
  1. 1.Gastrointestinal Surgery ServiceHospital Clinic BarcelonaBarcelonaSpain

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