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Surgical Endoscopy

, Volume 31, Issue 12, pp 4981–4987 | Cite as

Transanal Hartmann’s colostomy reversal assisted by laparoscopy: outcomes of the first 10 patients

  • Jean-Sébastien Trépanier
  • María Clara Arroyave
  • Raquel Bravo
  • Marta Jiménez-Toscano
  • Francisco B. DeLacy
  • María Fernandez-Hevia
  • Antonio M. Lacy
Article

Abstract

Introduction

Restoration of intestinal continuity after Hartmann’s procedure is a technically difficult surgery associated with significant morbidity and mortality. This study presents the short-term results of a new approach: a transanal Hartmann’s colostomy reversal assisted by laparoscopy.

Method

This is a retrospective analysis of data collected in one tertiary hospital, from October 2013 to November 2015.

Results

During the study period, there were ten cases of transanal Hartmann’s reversal. Reasons for Hartmann’s procedure were: complicated diverticulitis (4), anastomotic leak (3), and recto-sigmoid cancer (3). Rectal stump length was 10.4 ± 4.5 cm. Reconstruction was achieved in all patients. One low colorectal anastomosis was hand-sewn, the other 9 were stapled. Mean operative time was 204 ± 65 min. Diverting loop ileostomies were created in five patients and all were closed during the following year. One case required hand-assistance but there was no conversion to open surgery. Iatrogenic laparoscopic enterotomies occurred in four patients and all were repaired primarily without consequences. Three patients had a total of four post-operative complications: ileus (2), abdominal abscess and wound infection (1). None required reoperation. Mean length of stay was 7.2 ± 4.3 days. One required readmission.

Conclusion

A transanal Hartmann’s reversal assisted by laparoscopy is a new approach for a difficult surgery. It has the potential to be an additional tool in the case of hostile pelvises or with a rectal stump difficult to identify. The surgery remains challenging and indications need to be clarified.

Keywords

taTME Transanal Hartmann Colostomy Reconstruction Laparoscopy 

Notes

Acknowledgements

A video was presented at the SAGES 2016 Annual Meeting, March 16–19, 2016, Boston, Massachusetts, USA. An eposter was presented at the European Association for Endoscopic Surgery 24th International Congress, June 15–18th, 2016, Amsterdam, Netherlands. The authors would like to thank Aischannel.com for the media support.

Compliance with ethical standards

Disclosure

Jean-Sébastien Trépanier, María Clara Arroyave, Raquel Bravo, Marta Jiménez-Toscano, Francisco B. DeLacy, María Fernandez-Hevia and Antonio M. Lacy have no conflict of interest or financial ties to disclose.

References

  1. 1.
    Schmelzer TM, Mostafa G, Norton HJ, Newcomb WL, Hope WW, Lincourt AE, Kercher KW, Kuwada TS, Gersin KS, Heniford BT (2007) Reversal of Hartmann’s procedure: a high-risk operation? Surgery 142:598–607. doi: 10.1016/j.surg.2007.08.001 CrossRefPubMedGoogle Scholar
  2. 2.
    van de Wall BJM, Draaisma WA, Schouten ES, Broeders IAMJ, Consten ECJ (2009) Conventional and laparoscopic reversal of the Hartmann procedure: a review of literature. J Gastrointest Surg 14:743–752. doi: 10.1007/s11605-009-1084-3 CrossRefPubMedCentralGoogle Scholar
  3. 3.
    Sosa JL, Sleeman D, Puente I, McKenney MG, Hartmann R (1994) Laparoscopic-assisted colostomy closure after Hartmann’s procedure. Dis Colon Rectum 37:149–152CrossRefPubMedGoogle Scholar
  4. 4.
    Rosen MJ, Cobb WS, Kercher KW, Sing RF, Heniford BT (2005) Laparoscopic restoration of intestinal continuity after Hartmann’s procedure. Am J Surg 189:670–674. doi: 10.1016/j.amjsurg.2005.03.007 CrossRefPubMedGoogle 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 20:1883–1886. doi: 10.1007/s00464-005-0848-4 CrossRefPubMedGoogle Scholar
  6. 6.
    Haughn C, Ju B, Uchal M, Arnaud JP, Reed JF, Bergamaschi R (2008) Complication rates after Hartmannʼs reversal: open vs. laparoscopic approach. Dis Colon Rectum 51:1232–1236. doi: 10.1007/s10350-008-9264-x CrossRefPubMedGoogle Scholar
  7. 7.
    Yang PF, Morgan MJ (2014) Laparoscopic versus open reversal of Hartmann’s procedure: a retrospective review. ANZ J Surg 84:965–969. doi: 10.1111/ans.12667 CrossRefPubMedGoogle Scholar
  8. 8.
    Huynh H, Trottier DC, Soto CM, Moloo H, Poulin EC, Mamazza J, Boushey RP (2011) Laparoscopic colostomy reversal after a Hartmann procedure: a prospective series, literature review and an argument against laparotomy as the primary approach. Can J Surg 54:133–137. doi: 10.1503/cjs.013510 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Celentano V, Giglio MC, Bucci L (2015) Laparoscopic versus open Hartmann’s reversal: a systematic review and meta-analysis. Int J Colorectal Dis 30:1603–1615. doi: 10.1007/s00384-015-2325-4 CrossRefPubMedGoogle Scholar
  10. 10.
    Clermonts SHEM, de Ruijter WMJ, van Loon Y-TT, Wasowicz DK, Heisterkamp J, Maring JK, Zimmerman DDE (2016) Reversal of Hartmann’s procedure utilizing single-port laparoscopy: an attractive alternative to laparotomy. Surg Endosc 30:1894–1901. doi: 10.1007/s00464-015-4407-3 CrossRefPubMedGoogle Scholar
  11. 11.
    Carus T, Emmert A (2011) Single-port laparoscopic reversal of Hartmann’s procedure: technique and results. Minim Invasive Surg 2011:1–5. doi: 10.1155/2011/356784 CrossRefGoogle Scholar
  12. 12.
    Bravo R, Fernández-Hevia M, Jiménez-Toscano M, Flores LF, de Lacy B, Quaresima S, Lacy AM (2015) Transanal Hartmann reversal: a new technique. Surg Endosc. doi: 10.1007/s00464-015-4504-3 PubMedGoogle Scholar
  13. 13.
    Dindo D, Demartines N, Clavien P-A (2004) Classification of Surgical Complications. Ann Surg 240:205–213. doi: 10.1097/01.sla.0000133083.54934.ae CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Gorey TF, O’Connell PR, Waldron D, Cronin K, Kerin M, Fitzpatrick JM (1993) Laparoscopically assisted reversal of Hartmann’s procedure. Br J Surg 80:109CrossRefPubMedGoogle Scholar
  15. 15.
    Anderson CA, Fowler DL, White S, Wintz N (1993) Laparoscopic colostomy closure. Surg Laparosc Endosc 3:69–72PubMedGoogle Scholar
  16. 16.
    Arkenbosch J, Miyagaki H, Kumara HMCS, 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 29:1–6. doi: 10.1007/s00464-014-3926-7 CrossRefGoogle Scholar
  17. 17.
    Lacy AM, Tasende MM, Delgado S, Fernández-Hevia M, Jimenez M, De Lacy B, Castells A, Bravo R, Wexner SD, Heald RJ (2015) Transanal total mesorectal excision for rectal cancer: outcomes after 140 patients. J Am Coll Surg 221:415–423. doi: 10.1016/j.jamcollsurg.2015.03.046 CrossRefPubMedGoogle Scholar
  18. 18.
    Tasende MM, Delgado S, Jimenez M, Gobbo GD, Fernández-Hevia M, DeLacy B, Balust J, Lacy AM (2015) Minimal invasive surgery: NOSE and NOTES in ulcerative colitis. Surg Endosc 29:1–6. doi: 10.1007/s00464-015-4087-z CrossRefGoogle Scholar
  19. 19.
    Atallah S, Martin-Perez B, Albert M, deBeche-Adams T, Nassif G, Hunter L, Larach S (2014) Transanal minimally invasive surgery for total mesorectal excision (TAMIS-TME): results and experience with the first 20 patients undergoing curative-intent rectal cancer surgery at a single institution. Tech Coloproctol 18:473–480. doi: 10.1007/s10151-013-1095-7 CrossRefPubMedGoogle Scholar
  20. 20.
    Velthuis S, Nieuwenhuis DH, Ruijter TEG, Cuesta MA, Bonjer HJ, Sietses C (2014) Transanal versus traditional laparoscopic total mesorectal excision for rectal carcinoma. Surg Endosc 28:3494–3499. doi: 10.1007/s00464-014-3636-1 CrossRefPubMedGoogle Scholar
  21. 21.
    Fernández-Hevia M, Delgado S, Castells A, Tasende M, Momblan D, Díaz del Gobbo G, DeLacy B, Balust J, Lacy AM (2015) Transanal total mesorectal excision in rectal cancer. Ann Surg 261:221–227. doi: 10.1097/SLA.0000000000000865 CrossRefPubMedGoogle Scholar
  22. 22.
    Glotzer DJ, Glick ME, Goldman H (1981) Proctitis and colitis following diversion of the fecal stream. Gastroenterology 80:438–441PubMedGoogle Scholar
  23. 23.
    Roe AM, Prabhu S, Ali A, Brown C, Brodribb AJ (1991) Reversal of Hartmann’s procedure: timing and operative technique. Br J Surg 78:1167–1170CrossRefPubMedGoogle Scholar
  24. 24.
    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 37:243–248CrossRefPubMedGoogle Scholar
  25. 25.
    Pearce NW, Scott SD, Karran SJ (1992) Timing and method of reversal of Hartmann’s procedure. Br J Surg 79:839–841CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Jean-Sébastien Trépanier
    • 1
    • 2
  • María Clara Arroyave
    • 1
    • 3
  • Raquel Bravo
    • 1
  • Marta Jiménez-Toscano
    • 1
  • Francisco B. DeLacy
    • 1
  • María Fernandez-Hevia
    • 1
  • Antonio M. Lacy
    • 1
  1. 1.Department Barcelona, Gastrointestinal SurgeryHospital Clínic de BarcelonaBarcelonaSpain
  2. 2.Hôpital Maisonneuve-RosemontUniversité de MontréalMontrealCanada
  3. 3.Clínica SomerRionegroColombia

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