Incision-less reversal of Hartmann’s procedure

Abstract

After taking down the colostomy in a patient who has previously undergone a Hartmann’s operation, it is possible to restore bowel continuity using the single-port technique via the colostomy site itself. This study presents our experience of this approach using the glove port and standard laparoscopic instrumentation. Between October 2010 and October 2013, 14 patients [median age 62 years (range 42–83 years); median body mass index 25.2 kg/m² (range 22.7–34.9) kg/m²] underwent attempted single-port (via colostomy site) reversal of Hartmann’s. All but one patient had had a laparotomy for their primary surgery. The glove port was used with a camera and two working ports. Additional remote access was needed in 3 (21 %) patients [1 × 5 mm port (two patients); 2 × 5-mm ports ; 2 × 5-mm ports and Pfannenstiel]. Median operative time was 150 min (range 75–270 min). Mortality was nil. One patient required reoperation and a stoma. Median hospital stay was 5 days (range 2–36 days). Glove port reversal of Hartmann’s is technically possible, though challenging if extensive adhesions are present. Outcomes are variable. Further studies will be needed to assess whether this is a safe technique.