Abstract
Background
Complications after restoration of intestinal continuity (RIC) following Hartmann’s procedure occur frequently and are often serious. These complications result in a reported morbidity of 4–30 % and a reported mortality of 10–14 %. Reducing the amount of surgical trauma accompanying abdominal access seems an attractive tool to reduce perioperative morbidity. This possibility is offered by single-port Hartmann’s reversal (SPHR) through the colostomy site.
Methods
The purpose of the present prospective study was to compare outcome of SPHR to a retrospectively collected historical control group of conventional open Hartmann’s reversal (OHR). All patients undergoing RIC between January 1, 2009, and January 1, 2014, were included in the present study. Operation time, morbidity and hospital stay were assessed. Postoperative surgical results of SPHR and OHR were the main outcome of the study.
Results
During the study period, 41 patients (M/F = 23:18; median age 58 (26–85) years) were included in the present study. Sixteen patients underwent OHR; 25 patients underwent SPHR. No mortality was observed in the present series. Median operation time was similar between groups [184 (29–377) vs. 153.5 (73–332) min]. Hospital stay was significantly shorter in the SPHR group [16 (4–74) vs. 4 (1–34) days, p < 0.05]. The number of complications was significantly lower in the SPHR group (33 vs. 10, p < 0.05); furthermore, significantly less patients had severe complications (Clavien–Dindo III or higher) in the SPHR group (7/33 vs. 1/10). Less wound-related complications occurred in the SPHR group (12 vs. 5, p < 0.05).
Conclusion
This study confirms recent findings in the literature regarding the safety and feasibility of SPHR. SPHR seems to be an attractive alternative to OHR.
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References
Hartmann H (1923) Note sur un procede nouveau d’extripation des cancers de la partie terminale du colon. Bulletin et Memoires de la Societe Chirurgique de Paris 1923(00):1474–1477
Hartmann H (1921) Nouveau procede d’ablation des cancers de la partie terminale du colon pelvien. Strasbourg, Trentienne Congres de Chirurgie, pp 411–413
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):651–657
Leroy J, Cahill RA, Asakuma M, Dallemagne B, Marescaux J (2009) Single-access laparoscopic sigmoidectomy as definitive surgical management of prior diverticulitis in a human patient. Arch Surg 144(2):173–179 (discussion 9)
Nugent KP, Daniels P, Stewart B, Patankar R, Johnson CD (1999) Quality of life in stoma patients. Dis Colon Rectum 42(12):1569–1574
Mols F, Lemmens V, Bosscha K, van den Broek W, Thong MS (2014) Living with the physical and mental consequences of an ostomy: a study among 1–10-year rectal cancer survivors from the population-based PROFILES registry. Psycho-oncology
Pearce NW, Scott SD, Karran SJ (1992) Timing and method of reversal of Hartmann’s procedure. Br J Surg 79(8):839–841
Wigmore SJ, Duthie GS, Young IE, Spalding EM, Rainey JB (1995) Restoration of intestinal continuity following Hartmann’s procedure: the Lothian experience 1987–1992. Br J Surg 82(1):27–30
Albarran SA, Simoens C, Van De Winkel N, da Costa PM, Thill V (2009) Restoration of digestive continuity after Hartmann’s procedure: ASA score is a predictive factor for risk of postoperative complications. Acta Chir Belg 109(6):714–719
Banerjee S, Leather AJ, Rennie JA, Samano N, Gonzalez JG, Papagrigoriadis S (2005) Feasibility and morbidity of reversal of Hartmann’s. Colorect Dis 7(5):454–459
Maggard MA, Zingmond D, O’Connell JB, Ko CY (2004) What proportion of patients with an ostomy (for diverticulitis) get reversed? Am Surg 70(10):928–931
Vermeulen J, Vrijland W, Mannaerts GH (2008) Reversal of Hartmann’s procedure through the stomal side: a new even more minimal invasive technique. Surg Endosc 22(10):2319–2322
Rosen MJ, Cobb WS, Kercher KW, Heniford BT (2006) Laparoscopic versus open colostomy reversal: a comparative analysis. J Gastrointest Surg 10(6):895–900
Parkin E, Khurshid M, Ravi S, Linn T (2013) Surgical access through the stoma for laparoscopic reversal of Hartmann procedures. Surg Laparosc Endosc Percutan Tech 23(1):41–44
Carus T, Emmert A (2011) Single-port laparoscopic reversal of Hartmann’s procedure: technique and results. Minim Invas Surg 2011:356784
Joshi HM, Gosselink MP, Adusumilli S, Cunningham C, Lindsey I, Jones OM (2014) Incision-less reversal of Hartmann’s procedure. Tech Coloproctol
Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N et al (2013) Guidelines for perioperative care in elective colonic surgery: enhanced recovery after surgery (ERAS((R))) Society recommendations. World J Surg 37(2):259–284
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
Faure JP, Doucet C, Essique D, Badra Y, Carretier M, Richer JP et al (2007) Comparison of conventional and laparoscopic Hartmann’s procedure reversal. Surg Laparosc Endosc Percutan Tech 17(6):495–499
Mazeh H, Greenstein AJ, Swedish K, Nguyen SQ, Lipskar A, Weber KJ et al (2009) Laparoscopic and open reversal of Hartmann’s procedure—a comparative retrospective analysis. Surg Endosc 23(3):496–502
Lahat G, Tulchinsky H, Goldman G, Klauzner JM, Rabau M (2005) Wound infection after ileostomy closure: a prospective randomized study comparing primary vs. delayed primary closure techniques. Techniques 9(3):206–208
Vermulst N, Vermeulen J, Hazebroek EJ, Coene PP, van der Harst E (2006) Primary closure of the skin after stoma closure. Management of wound infections is easy without (long-term) complications. Digest Surg 23(4):255–258
Hackam DJ, Rotstein OD (1995) Wound infection during stoma closure. Can J Surg 38(2):191
Harold DM, Johnson EK, Rizzo JA, Steele SR (2010) Primary closure of stoma site wounds after ostomy takedown. Am J Surg 199(5):621–624
Polle SW, Dunker MS, Slors JF, Sprangers MA, Cuesta MA, Gouma DJ et al (2007) Body image, cosmesis, quality of life, and functional outcome of hand-assisted laparoscopic versus open restorative proctocolectomy: long-term results of a randomized trial. Surg Endosc 21(8):1301–1307
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S. Clermonts, W.de Ruijter, Yu-ting T. van Loon, D. Wasowicz, J. Heisterkamp, J. Maring and D. Zimmerman have no conflict of interest or financial ties to disclose.
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Clermonts, S.H.E.M., de Ruijter, W.M.J., van Loon, Yt.T. et al. Reversal of Hartmann’s procedure utilizing single-port laparoscopy: an attractive alternative to laparotomy. Surg Endosc 30, 1894–1901 (2016). https://doi.org/10.1007/s00464-015-4407-3
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DOI: https://doi.org/10.1007/s00464-015-4407-3