1
|
Kang BM, Kim CW, Lee SH. Laparoscopic Hartmann's Reversal: Application of a Single-Port Approach Through the Colostomy Site. Ann Coloproctol 2021; 37:29-34. [PMID: 33332955 PMCID: PMC7989560 DOI: 10.3393/ac.2020.09.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/22/2020] [Accepted: 09/21/2020] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Recently, laparoscopic reversal of Hartmann's colostomy was performed with favorable outcomes by many surgeons. We partially applied the concepts of single-port laparoscopic procedure through the colostomy site to remove intraperitoneal adhesion during initial step of the laparoscopic Hartmann's reversal. This study aimed to evaluate the feasibility and safety of the laparoscopic reversal of Hartmann's colostomy with the application of single-port laparoscopic techniques through the colostomy site. METHODS From October 2008 to November 2018, the laparoscopic Hartmann's reversal was attempted in 20 patients. After colostomy take-downs, the single-port device was installed at the colostomy site and the single-port laparoscopic procedure was performed to remove intraperitoneal adhesions to provide space for additional trocars. After additional trocars were inserted, the descending colon and rectal stump were mobilized, and the colorectal anastomosis was completed. We retrospectively reviewed the medical records and analyzed the data to identify the perioperative complication rates as the primary outcome. RESULTS Of the 20 patients, 3 patients (15.0%) had open conversions due to severe adhesions. Intraoperative small bowel injuries occurred in 2 patients (10.0%) and these were repaired through the colostomy site. Postoperative complications developed in 4 patients (20.0%) and were managed with medical treatments or wound closures under local anesthesia. CONCLUSION The single-port laparoscopic procedure through the colostomy site is sufficiently safe in order to complete the Hartmann's reversal. We recommend that the colostomy site should be used as the access route into the abdominal cavity for the Hartmann's reversal.
Collapse
Affiliation(s)
- Byung Mo Kang
- Department of Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Chang Woo Kim
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Suk-Hwan Lee
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| |
Collapse
|
2
|
Horesh N, Lessing Y, Rudnicki Y, Kent I, Kammar H, Ben-Yaacov A, Dreznik Y, Avital S, Mavor E, Wasserberg N, Kashtan H, Klausner J, Gutman M, Zmora O, Tulchinsky H. Comparison between laparoscopic and open Hartmann's reversal: results of a decade-long multicenter retrospective study. Surg Endosc 2018; 32:4780-4787. [PMID: 29766303 DOI: 10.1007/s00464-018-6227-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/09/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hartmann's reversal is a challenging surgical procedure with significant postoperative morbidity rates. Various surgical methods have been suggested to lower the risk of postoperative complications. In this study, we aimed to compare the postoperative results between open and laparoscopic techniques for Hartmann's reversal. METHODS A retrospective study of all patients who underwent Hartmann's reversal in five centers in central Israel between January 2004 and June 2015 was conducted. Medical charts were reviewed, analyzing preoperative and operative parameters and short-term postoperative outcomes. RESULTS 260 patients were included in the study. 76 patients were operated laparoscopically with a conversion rate of 26.3% (20 patients). No differences were found between patients operated laparoscopically and those operated in an open technique regarding gender (p = 0.785), age (61.34 vs. 62.64, p = 0.521), body mass index (26.6 vs. 26.2, p = 0.948), Charlson index score (1.79 vs. 1.95, p = 0.667), and cause for Hartmann's procedure (neoplastic vs. non-neoplastic, p = 0.644). No differences were seen in average time from the Hartmann's procedure to reversal (204.89 vs. 213.60 days, p = 0.688) and in overall complication rate (46.4 vs. 46.5%, p = 1). The Clavien-Dindo score for distinguishing between minor (0-2 score, p = 1) and major complications (3-5 score, p = 0.675) failed to demonstrate an advantage to laparoscopy, as well as to average length of stay (10.91 days in the laparoscopic group vs. 11.72 days in the open group, p = 0.529). An analysis based on the intention-to-treat with laparoscopy, including converted cases in the laparoscopic group, showed similar results, including overall complication rate (48.6 vs. 45.6%, p = 0.68) and Clavien-Dindo score in both minor (p = 0.24) and major complications (p = 0.44). Length of stay (10.92 vs. 11.81 days, p = 0.45) was also similar between the two groups. CONCLUSION In this series, a laparoscopic approach to Hartmann's reversal did not offer any short-term advantage when compared to an open surgical approach.
Collapse
Affiliation(s)
- Nir Horesh
- Department of General Surgery and Transplantations B, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yonatan Lessing
- Division of Surgery, Tel-Aviv Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Rudnicki
- Department of Surgery B, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Kent
- Department of Surgery B, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haguy Kammar
- Department of Surgery, Kaplan Medical Center, Rehovot, Israel
- School of Medicine, Hadassah-Hebrew University, Jerusalem, Israel
| | - Almog Ben-Yaacov
- Department of Surgery B, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Dreznik
- Department of General Surgery and Transplantations B, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Avital
- Department of Surgery B, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Mavor
- Department of Surgery, Kaplan Medical Center, Rehovot, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Wasserberg
- Department of Surgery B, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hanoch Kashtan
- Department of Surgery B, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph Klausner
- Division of Surgery, Tel-Aviv Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of General Surgery and Transplantations B, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Zmora
- Department of General Surgery and Transplantations B, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagit Tulchinsky
- Division of Surgery, Tel-Aviv Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
3
|
Reversal of Hartmann’s procedure: still a complicated operation. Tech Coloproctol 2017; 22:81-87. [DOI: 10.1007/s10151-017-1735-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 11/19/2017] [Indexed: 12/11/2022]
|
4
|
Cassini D, Miccini M, Manoochehri F, Gregori M, Baldazzi G. Emergency Hartmann's Procedure and Its Reversal: A Totally Laparoscopic 2-Step Surgery for the Treatment of Hinchey III and IV Diverticulitis. Surg Innov 2017; 24:557-565. [PMID: 28748737 DOI: 10.1177/1553350617722226] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hartmann's procedure (HP) followed by reversal restoration is the first choice for treatment of diffuse diverticular peritonitis. There is no unanimous consensus regarding the use of laparoscopy to treat the same condition. METHODS Data from 60 patients with diverticular diffuse peritonitis who underwent urgent HP followed by laparoscopic reversal were retrospectively analyzed. Patients were divided into 2 groups according to the open or laparoscopic HP (OHP, 24 patients; LHP, 36 patients). Outcomes were measured in terms of functional recovery, morbidity, mortality, and length of hospital stay. RESULTS HPs showed no differences among the groups in terms of operative time, blood loss, and length of intensive care unit stay. Overall morbidity was significantly lower in LHP than in OHP, corresponding to 33.3% and 66.7% respectively ( P = .018). The incidence of both surgical and medical complications was higher in OHP than in LHP (41.7% vs 22.2% [ P = .044] and 45.8% vs 24.3% [ P = .023], respectively). Mortality was 16.6% for each group. LHP showed a faster return to bowel movements and a shorter hospital stay than OHP. The secondary intestinal reversal was possible in 92% of cases, successfully completed laparoscopically in 91.3%. No patients of LHP group required a conversion to open intestinal reversal. CONCLUSION LHP for treatment of diverticular diffuse peritonitis showed significantly lower morbidity, faster recovery, shorter hospital stay, and higher rates of successful laparoscopic reversal when compared with OHP.
Collapse
|
5
|
Kwak HD, Kim J, Kang DW, Baek SJ, Kwak JM, Kim SH. Hartmann's reversal: a comparative study between laparoscopic and open approaches. ANZ J Surg 2017; 88:450-454. [PMID: 28730630 DOI: 10.1111/ans.13979] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/13/2017] [Accepted: 02/27/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND A reversal of Hartmann's procedure can be performed using either a laparoscopic or open approach. However, laparoscopic reversal (LR) of Hartmann's procedure is challenging. This study was designed to compare the results between open and laparoscopic approaches. METHODS This was a retrospective study of prospectively collected data. We analysed 29 patients who received Hartmann's reversal at Korea University Anam Hospital between April 2007 and September 2014. All patients underwent either LR (n = 17) or open reversal (OR, n = 12). RESULTS Patient characteristics were similar between the LR and OR groups. There was also no difference in mean operation time (212.5 versus 251.8 min), diversion ileostomy, length of hospital stay, postoperative analgesic days, time to diet resumption (3.9 versus 6.2 days) or complication rate. Although the time to resuming a solid diet was not different between the two groups (P = 0.053), bowel movement occurred faster in LR patients (LR versus OR, 1.8 versus 2.8 days, P = 0.020). Patients in the LR group also had less blood loss during surgery (114.1 versus 594.2 mL, P = 0.026). There were no mortalities in this study. CONCLUSION LR of Hartmann's procedure resulted in faster bowel function recovery than the open method. Laparoscopic approaches are feasible even for patients who received an open Hartmann's procedure.
Collapse
Affiliation(s)
- Han Deok Kwak
- Department of Surgery, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jin Kim
- Department of Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Dong Woo Kang
- Department of Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Se-Jin Baek
- Department of Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jung Myun Kwak
- Department of Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Seon-Hahn Kim
- Department of Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| |
Collapse
|
6
|
Trépanier JS, Arroyave MC, Bravo R, Jiménez-Toscano M, DeLacy FB, Fernandez-Hevia M, Lacy AM. Transanal Hartmann's colostomy reversal assisted by laparoscopy: outcomes of the first 10 patients. Surg Endosc 2017; 31:4981-4987. [PMID: 28612145 DOI: 10.1007/s00464-017-5462-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 02/09/2017] [Indexed: 12/15/2022]
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.
Collapse
Affiliation(s)
- Jean-Sébastien Trépanier
- Department Barcelona, Gastrointestinal Surgery, Hospital Clínic de Barcelona, Carrer de Villaroel 170, 08036, Barcelona, Catalonia, Spain.,Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Assomption, Montreal, Quebec, H1T 2M4, Canada
| | - María Clara Arroyave
- Department Barcelona, Gastrointestinal Surgery, Hospital Clínic de Barcelona, Carrer de Villaroel 170, 08036, Barcelona, Catalonia, Spain.,Clínica Somer, Calle 38 #35A-54, Rionegro, Antioquia, Colombia
| | - Raquel Bravo
- Department Barcelona, Gastrointestinal Surgery, Hospital Clínic de Barcelona, Carrer de Villaroel 170, 08036, Barcelona, Catalonia, Spain
| | - Marta Jiménez-Toscano
- Department Barcelona, Gastrointestinal Surgery, Hospital Clínic de Barcelona, Carrer de Villaroel 170, 08036, Barcelona, Catalonia, Spain
| | - Francisco B DeLacy
- Department Barcelona, Gastrointestinal Surgery, Hospital Clínic de Barcelona, Carrer de Villaroel 170, 08036, Barcelona, Catalonia, Spain
| | - María Fernandez-Hevia
- Department Barcelona, Gastrointestinal Surgery, Hospital Clínic de Barcelona, Carrer de Villaroel 170, 08036, Barcelona, Catalonia, Spain
| | - Antonio M Lacy
- Department Barcelona, Gastrointestinal Surgery, Hospital Clínic de Barcelona, Carrer de Villaroel 170, 08036, Barcelona, Catalonia, Spain.
| |
Collapse
|
7
|
Melkonian E, Heine C, Contreras D, Rodriguez M, Opazo P, Silva A, Robles I, Rebolledo R. Reversal of the Hartmann's procedure: A comparative study of laparoscopic versus open surgery. J Minim Access Surg 2017; 13:47-50. [PMID: 27251820 PMCID: PMC5206839 DOI: 10.4103/0972-9941.181329] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND: The Hartmann's operation, although less frequently performed today, is still used when initial colonic anastomosis is too risky in the short term. However, the subsequent procedure to restore gastrointestinal continuity is associated with significant morbidity and mortality. PATIENTS AND METHODS: The review of an institutional review board (IRB)-approved prospectively maintained database provided data on the Hartmann's reversal procedure performed by either laparoscopic or open technique at our institution. The data collected included: demographic data, operative approach, conversion for laparoscopic cases and perioperative morbidity and mortality. RESULTS: Over a 14-year period from January 1997 to August 2011, 74 Hartmann's reversal procedures were performed (laparoscopic surgery—49, open surgery—25). The average age was 55 years for the laparoscopic and 57 years for the open surgery group, respectively. Male patients represent 61% of both groups. There was no significant difference in operative time between the two groups (149 min vs 151 min; P = 0.95), and there was a tendency to lower morbidity (3/49—7.3% vs 4/25—16%; P = 0.24) in the laparoscopic surgery group. In the laparoscopic group, eight patients (16.3%) were converted to open surgery, mostly due to severe adhesions. The length of hospital stay was significantly shorter for the laparoscopic group (5 days vs 7 days; P = 0.44). CONCLUSIONS: The Hartmann's reversal procedure can be safely performed in the majority of the cases using a laparoscopic approach with a low morbidity rate and achieving a shorter hospital stay.
Collapse
Affiliation(s)
- Ernesto Melkonian
- Colorectal Surgery Unit, Hospital del Salvador; Department of Colon and Rectal Surgery, Clinica Alemana, Santiago, Chile
| | - Claudio Heine
- Colorectal Surgery Unit, Hospital del Salvador, Santiago, Chile
| | - David Contreras
- Colorectal Surgery Unit, Hospital del Salvador, Santiago, Chile
| | | | - Patricio Opazo
- Colorectal Surgery Unit, Hospital del Salvador, Santiago, Chile
| | - Andres Silva
- Colorectal Surgery Unit, Hospital del Salvador, Santiago, Chile
| | - Ignacio Robles
- Colorectal Surgery Unit, Hospital del Salvador, Santiago, Chile
| | | |
Collapse
|
8
|
Lucchetta A, De Manzini N. Laparoscopic reversal of Hartmann procedure: is it safe and feasible? Updates Surg 2016; 68:105-10. [DOI: 10.1007/s13304-016-0363-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 03/23/2016] [Indexed: 01/19/2023]
|
9
|
Shaw D, Beaty JS, Thorson AG. Reoperative surgery for diverticular disease and its complications. SEMINARS IN COLON AND RECTAL SURGERY 2015. [DOI: 10.1053/j.scrs.2015.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
10
|
Transanal Hartmann reversal: a new technique. Surg Endosc 2015; 30:2628-31. [PMID: 26423412 DOI: 10.1007/s00464-015-4504-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 08/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS As in patients with rectal cancer, dissection of the stump in Hartmann reversal procedure may be better and associated with shorter operative time. CONCLUSIONS 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.
Collapse
|
11
|
Zimmermann M, Hoffmann M, Laubert T, Meyer KF, Jungbluth T, Roblick UJ, Bruch HP, Schlöricke E. Laparoscopic versus open reversal of a Hartmann procedure: a single-center study. World J Surg 2015; 38:2145-52. [PMID: 24668452 DOI: 10.1007/s00268-014-2507-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Re-anastomosis after a Hartmann procedure is associated with a higher morbidity and mortality than other elective colorectal operations. The goal of this comparative study was to evaluate whether laparoscopic reversal is a justified operative approach, although the initial operation is most often an emergency laparotomy. METHODS A retrospective analysis was conducted on data collected on all 70 patients who underwent laparoscopic and open reversal of a Hartmann procedure at the Department of Surgery, University of Schleswig-Holstein, Campus Lübeck, between January 1999 and December 2011. Together with general demographic data, the analysis included the indication for the initial Hartmann procedure, time to reversal, intraoperative findings, the choice of operative method, operating time, postoperative pain control, return of normal bowel function, length of hospital stay, and peri- and postoperative morbidity and mortality. RESULTS In most patients, the Hartmann procedure was performed after a perforated sigmoid diverticulitis. We were not able to find any statistically significant differences with respect to gender, body mass index (BMI) and American Society of Anesthesiologists classification between the laparoscopic group (LG) (N = 24 patients) and the open group (OG) (N = 46). In the LG, patients were significantly younger (p = 0.019). The median operating time was 210 min (75-245) in the LG, which was significantly longer than in the OG (166 min; 66-230). The statistical analysis of the duration of postoperative analgesic therapy (LG 7 days; OG 12 days), return to normal diet (LG 3 days; OG 4 days), return of normal bowel function (LG 3 days; OG 4 days) and length of hospital stay (LOS) (LG 10 days; OG 15 days) detected significant differences in advantage for the LG. Unplanned return to theatre during index admission was only necessary in the OG (N = 7, 15.2 %). With a median follow-up of 8 months (range 1-20), we observed a comparable number of minor complications in both groups but a significantly higher number of major complications in the OG (N = 27, 58.7%) (p = 0.001). Conversion occurred in three cases (12.5%). There was no mortality in either of the two groups. CONCLUSIONS This study was able to demonstrate the feasibility of the laparoscopic approach. In terms of postoperative results it should be seen as equivalent to the open procedure. However, the laparoscopic approach requires profound surgical expertise. The indication should be made after a careful risk/benefit analysis for each individual patient.
Collapse
Affiliation(s)
- Markus Zimmermann
- Department of Surgery, University of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany,
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Laparoscopic reversal of Hartmann's procedure. Updates Surg 2014; 66:277-81. [PMID: 25262377 DOI: 10.1007/s13304-014-0268-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 09/20/2014] [Indexed: 12/18/2022]
Abstract
Reestablishing continuity after a Hartmann's procedure is considered a major surgical procedure with high morbidity/mortality. The aim of this study was to assess the short-/long-term outcome of laparoscopic restoration of bowel continuity after HP. A prospectively collected database of colorectal laparoscopic procedures (>800) performed between June 2005 and June 2013 was used to identify 20 consecutive patients who had undergone laparoscopic reversal of Hartmann's procedure (LHR). Median age was 65.4. Ten patients (50 %) had undergone surgery for perforated diverticulitis, 3 (15 %) for cancer, and 7 (35 %) for other reasons (volvulus, posttraumatic perforation, and sigmoid perforation from foreign body). Previous HP had been performed laparoscopically in only 3 patients. Median operative time was 162.5 min. All the procedures were completed laparoscopically. Intraoperative complication rate was nil. Post-operative mortality and morbidity were respectively 0 and 10 % (1 pneumonia, 1 bowel obstruction from post-anastomotic stenosis which required resection and redo of the anastomosis). Median time to first flatus was 3 days, to normal diet 5 days. Median hospital stay was 9 days without readmissions. We followed up the patients for a median of 44 months: when asked, all 20 (100 %) said they would undergo the operation (LHR) again; 3 (15 %) had been re-operated of laparoscopic mesh repair for incisional hernia. When performed by experienced surgeons, LHR is a feasible, safe, reproducible operation, which allows early return of bowel function, early discharge and fast return to work for the patient. It has a low morbidity rate.
Collapse
|
13
|
Toro A, Ardiri A, Mannino M, Politi A, Di Stefano A, Aftab Z, Abdelaal A, Arcerito MC, Cavallaro A, Cavallaro M, Bertino G, Di Carlo I. Laparoscopic Reversal of Hartmann's Procedure: State of the Art 20 Years after the First Reported Case. Gastroenterol Res Pract 2014; 2014:530140. [PMID: 25210510 PMCID: PMC4158170 DOI: 10.1155/2014/530140] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 07/01/2014] [Accepted: 07/03/2014] [Indexed: 12/13/2022] Open
Abstract
Introduction. Aim of the present work is to review the literature to point out the role of laparoscopic reversal of Hartmann procedure. Material and Methods. Number of patients, age, sex, etiology, Hinchey classification, interval between procedure and reversal, position of the first trocars, mean operative time (min), number and causes of conversion, length of stay, mortality, complications, and quality of life were considered. Results. 238 males (52.4%) and 216 females (47.6%) between 38 and 67 years were analyzed. The etiology was diverticulitis in 292 patients (72.1%), carcinoma in 43 patients (10.6%), and other in 70 patients (17.3%). Only 7 articles (22.6%) reported Hinchey classification. The interval between initial procedure and reversal was between 50 and 330 days. The initial trocar was open positioned in 182 patients (43.2%) through umbilical incision, in 177 patients (41.9%) in right upper quadrant, and in 63 patients (14.9%) in colostomy site. The operative time was between 69 and 285 minutes. A total of 83 patients (12.1%) were converted and the causes were reported in 67.4%. The length of stay was between 3 and 12 days. 5 patients (0.7%) died. The complications concern 112 cases (16.4%). Conclusion. The laparoscopic Hartmann's reversal is safer and achieves faster positive results.
Collapse
Affiliation(s)
- Adriana Toro
- Department of Surgery, Taormina Hospital, 98034 Messina, Italy
| | - Annalisa Ardiri
- Hepatology Unit, Department of Medical and Pediatric Science, University of Catania, 95100 Catania, Italy
| | - Maurizio Mannino
- Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, Cannizzaro Hospital, Via Messina 829, 95100 Catania, Italy
| | - Antonio Politi
- Department of Surgery, Cannizzaro Hospital, 95126 Catania, Italy
| | | | - Zia Aftab
- Department of Surgery, Hamad General Hospital, P.O. Box 3050 Doha, Qatar
| | | | - Maria Concetta Arcerito
- Endocrine Surgical Unit, “Policlinico e Vittorio Emanuele” Hospital, University of Catania, 95100 Catania, Italy
| | - Andrea Cavallaro
- General Surgery and Senology Unit, Department of Surgery, “Policlinico e Vittorio Emanuele” Hospital, University of Catania Medical School, 95100 Catania, Italy
| | | | - Gaetano Bertino
- Hepatology Unit, Department of Medical and Pediatric Science, University of Catania, 95100 Catania, Italy
| | - Isidoro Di Carlo
- Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, Cannizzaro Hospital, Via Messina 829, 95100 Catania, Italy
- Department of Surgery, Hamad General Hospital, P.O. Box 3050 Doha, Qatar
| |
Collapse
|
14
|
de'Angelis N, Felli E, Azoulay D, Brunetti F. Robotic-assisted reversal of Hartmann's procedure for diverticulitis. J Robot Surg 2014; 8:381-3. [PMID: 25419246 PMCID: PMC4236621 DOI: 10.1007/s11701-014-0458-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 02/25/2014] [Indexed: 02/01/2023]
Abstract
The minimally invasive laparoscopic approach for the reversal of Hartmann's procedure (HP) has been shown to be a safe and feasible approach associated with low morbidity and fast recovery. Robotic surgery has not yet been described for HP reversal. We report the case of an 84-year-old man originally operated on in an emergency setting by conventional HP for complicated diverticulitis who underwent a robotic-assisted HP reversal. The surgical procedure and the post-operative follow-up were uneventful, with low post-operative pain, early return to bowel function, and discharge at day 3. The robotic surgery appeared to be a safe, feasible, and valuable approach for HP reversal.
Collapse
Affiliation(s)
- Nicola de'Angelis
- Digestive Surgery and Liver Transplant Unit, Henri-Mondor Hospital, Université Paris Est, UPEC, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Emanuele Felli
- Digestive Surgery and Liver Transplant Unit, Henri-Mondor Hospital, Université Paris Est, UPEC, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Daniel Azoulay
- Digestive Surgery and Liver Transplant Unit, Henri-Mondor Hospital, Université Paris Est, UPEC, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Francesco Brunetti
- Digestive Surgery and Liver Transplant Unit, Henri-Mondor Hospital, Université Paris Est, UPEC, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| |
Collapse
|
15
|
de’Angelis N, Brunetti F, Memeo R, Batista da Costa J, Schneck AS, Carra MC, Azoulay D. Comparison between open and laparoscopic reversal of Hartmann’s procedure for diverticulitis. World J Gastrointest Surg 2013; 5:245-251. [PMID: 23983906 PMCID: PMC3753438 DOI: 10.4240/wjgs.v5.i8.245] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 06/29/2013] [Accepted: 07/19/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the open and laparoscopic Hartmann’s reversal in patients first treated for complicated diverticulitis.
METHODS: Forty-six consecutive patients with diverticular disease were included in this retrospective, single-center study of a prospectively maintained colorectal surgery database. All patients underwent conventional Hartmann’s procedures for acute complicated diverticulitis. Other indications for Hartmann’s procedures were excluded. Patients underwent open (OHR) or laparoscopic Hartmann’s reversal (LHR) between 2000 and 2010, and received the same pre- and post-operative protocols of cares. Operative variables, length of stay, short- (at 1 mo) and long-term (at 1 and 3 years) post-operative complications, and surgery-related costs were compared between groups.
RESULTS: The OHR group consisted of 18 patients (13 males, mean age ± SD, 61.4 ± 12.8 years), and the LHR group comprised 28 patients (16 males, mean age 54.9 ± 14.4 years). The mean operative time and the estimated blood loss were higher in the OHR group (235.8 ± 43.6 min vs 171.1 ± 27.4 min; and 301.1 ± 54.6 mL vs 225 ± 38.6 mL respectively, P = 0.001). Bowel function returned in an average of 4.3 ± 1.7 d in the OHR group, and 3 ± 1.3 d in the LHR group (P = 0.01). The length of hospital stay was significantly longer in the OHR group (11.2 ± 5.3 d vs 6.7 ± 1.9 d, P < 0.001). The 1 mo complication rate was 33.3% in the OHR (6 wound infections) and 3.6% in the LHR group (1 hemorrhage) (P = 0.004). At 12 mo, the complication rate remained significantly higher in the OHR group (27.8% vs 10.7%, P = 0.03). The anastomotic leak and mortality rates were nil. At 3 years, no patient required re-intervention for surgical complications. The OHR procedure had significantly higher costs (+56%) compared to the LHR procedure, when combining the surgery-related costs and the length of hospital stay.
CONCLUSION: LHR appears to be a safe and feasible procedure that is associated with reduced hospitality stays, complication rates, and costs compared to OHR.
Collapse
|
16
|
Maitra RK, Pinkney TD, Mohiuddin MK, Maxwell-Armstrong CA, Williams JP, Acheson AG. Should laparoscopic reversal of Hartmann's procedure be the first line approach in all patients? Int J Surg 2013; 11:971-6. [PMID: 23792268 DOI: 10.1016/j.ijsu.2013.06.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 05/29/2013] [Accepted: 06/09/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND/AIMS To assess if the laparoscopic reversal of Hartmann's can be attempted in all patients, without detriment to short or long-term outcomes if the patient is subsequently converted to open. METHODS Retrospective review of a prospectively collected database of all reversals under 8 surgeons at a single unit over 105 months, two surgeons attempting laparoscopic reversal in all patients, two pre-selecting for the laparoscopic approach and four utilising the open approach. Long-term follow-up data for re-admissions, re-operations and incisional hernia rate obtained from a postal questionnaire. RESULTS 45 laparoscopic and 50 primary open reversals were identified. There was no difference in the mean age or previous peritonitis rate in either group. Laparoscopic conversion rate was 29% (13 patients). On intention to treat analysis, a significant difference was identified in the overall 30-day post-operative surgical morbidity (8.9% Laparoscopic-attempted vs 26.0% Open, p = 0.030). There was no difference in operating times (mean 164 vs 172 min, p = 0.896) despite the 13 patients converted to an open procedure. Mean length of stay was significantly lower in the laparoscopic-attempted group at 6.8 days (5.2-8.4) vs 14.9 days (6.4-23.7) in the open group (p = 0.001). Anastomotic leak rates were not statistically different. The median follow up was 27 months (range 6-105); 60% of patients completed a postal follow-up questionnaire. There was no difference in short-term or long-term re-admission or reoperation rates. CONCLUSIONS Laparoscopic reversal of Hartamann's is associated with shorter hospital stay and lower morbidity even in unselected patients. Long-term outcomes are similar.
Collapse
Affiliation(s)
- R K Maitra
- Digestive Diseases and Thoracics Directorate, Nottingham University Hospitals NHS Trust, Queens Medical Centre, E Floor, West Block, Nottingham NG7 2UH, United Kingdom.
| | | | | | | | | | | |
Collapse
|
17
|
Cellini C, Deeb AP, Sharma A, Monson JRT, Fleming FJ. Association between operative approach and complications in patients undergoing Hartmann's reversal. Br J Surg 2013; 100:1094-9. [PMID: 23696424 DOI: 10.1002/bjs.9153] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Complications following reversal of Hartmann's procedure are common, with morbidity rates of up to 50 per cent, and a mortality rate as high as 10 per cent. This is based on case series with heterogeneous data collection and analysis. This study determined risk factors for complications following Hartmann's reversal. METHODS Patients who underwent elective open and laparoscopic Hartmann's reversal were identified from the American College of Surgeons National Surgical Quality Improvement Program database (2005-2010). The programme collects patient demographics, preoperative medical history, clinical findings and laboratory investigations. Postdischarge data were obtained by a certified reviewer. Complications were categorized as major, septic or incisional. Risk-adjusted 30-day outcomes were assessed by univariable and multivariable analyses, adjusting for patient characteristics, co-morbidity and operative approach. RESULTS During the study period 7996 patients had a Hartmann's procedure and 2567 cases of Hartmann's reversal were identified, including 336 laparoscopic procedures (13·1 per cent). Major, septic and incisional complication rates were 13·3, 8·5 and 15·7 per cent respectively, with a mortality rate of 0·5 per cent. A laparoscopic approach was found to be independently associated with fewer major (odds ratio (OR) 0·53, 95 per cent confidence interval 0·34 to 0·81), septic (OR 0·48, 0·27 to 0·83) and incisional (OR 0·54, 0·37 to 0·80) complications. A history of chronic obstructive pulmonary disease (OR 1·78-2·00), steroid use (OR 1·75), body mass index at least 30 kg/m² (OR 1·48), diabetes (OR 1·40), smoking (OR 1·33-1·40), American Society of Anesthesiologists fitness grade III and IV (OR 1·46-1·48) and prolonged operating time (OR 1·02) were other factors associated with complications. CONCLUSION A laparoscopic approach to Hartmann's reversal was associated with fewer complications than open surgery in this highly selected group of patients.
Collapse
Affiliation(s)
- C Cellini
- Division of Colorectal Surgery and Surgical Health Outcomes & Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, NY 14642, USA
| | | | | | | | | |
Collapse
|
18
|
Park JM, Chi KC. Laparoscopic reversal of Hartmann's procedure. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 82:256-60. [PMID: 22493768 PMCID: PMC3319781 DOI: 10.4174/jkss.2012.82.4.256] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 11/23/2011] [Accepted: 12/01/2011] [Indexed: 01/28/2023]
Abstract
Reversal of Hartmann's procedure is a major surgical procedure associated with significant morbidity and mortality. Because of the difficulty of the procedure, laparoscopic reversal of Hartmann's procedure is not well established. We describe our experience with this laparoscopic procedure to assess its difficulty and safety. Five patients (4 men and 1 woman) underwent laparoscopic reversal of Hartmann's procedure (LRHP). The initial surgeries were performed to manage obstructive colorectal cancer for 4 patients, and rectovesical fistula for one patient. The procedure was laparoscopically completed for 4 patients. Conversion to open laparotomy was required for one patient, secondary to massive adhesion in lower abdomen. Transient ileostomies were made in 2 cases. Operative time ranged from 240 to 545 minutes. There was no operative mortality. LRHP can be performed safely by an experienced surgeon. However, it is still technically challenging and time consuming.
Collapse
Affiliation(s)
- Joong-Min Park
- Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | | |
Collapse
|
19
|
Laparoscopic restoration of intestinal continuity (the LapRICon procedure): a safe and feasible technique for restoration of transanal defecation. Surg Endosc 2012; 26:1946-51. [PMID: 22234592 DOI: 10.1007/s00464-011-2132-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 12/08/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND The restoration of intestinal continuity after open abdominal surgery can be technically challenging. The authors describe their experience with the laparoscopic approach to attempted reversal for patients with an exteriorized intestine. METHODS A consecutive series of patients under the care of a single surgeon (D.B.) underwent laparoscopic restoration of intestinal continuity (LapRICon). All the patients first underwent exclusion of intraabdominal sepsis with computed tomography (CT) scanning and then preoperative localization of proximal and distal bowel ends via water-soluble contrast studies. Stomal sites were used for initial access, establishment of capnoperitoneum, and formation of anastomoses extracorporeally. All adhesiolysis and mobilization of bowel ends were performed intracorporeally. Pre-, intra-, and postoperative data were collected for all the patients. Return of intestinal function, overall hospital length of stay, and postoperative complications were collected. Nonparametric statistics were used to analyze the data. RESULTS A total of 13 patients (6 women) were followed up for 9 months (interquartile range [IQR], 5-16 months). The median age of the patients was 39 years (IQR, 28-64 years). Nine patients were categorized as American Society of Anesthesiology (ASA) class 1. One patient was ASA 2, and the remaining patients were ASA 3. The median colorectal physiologic and operative severity scores for the enumeration of mortality and morbidity (CR-POSSUM) were 0.68 (IQR, 0.68-1.72). The intraoperative blood loss was minimal (median 30 ml; IQR, 20-125 ml). The median operative duration was 240 min (IQR, 180-240 min), and a median of 4 ports (IQR, 3-5 ports) were used. Enterocolonic anastomoses were fashioned in six patients, enterorectal anastomoses in two patients, and enteroentero anastomoses in three patients. A single patient had multiple anastomoses. The median time to return of intestinal function was 5 days (IQR, 3-13 days), and the overall hospital stay was 8 days (IQR, 5-24 days). Four complications (25%) (2 recurrent fistulas, 1 anastomotic leak, and 1 open conversion) occurred in this series of patients. CONCLUSIONS The LapRICon procedure is a feasible technique with acceptable morbidity. Several principles and techniques are described to aid the surgeon who wishes to embark on use of such a technique.
Collapse
|
20
|
Costantino F, Mutter D, D'Agostino J, Dente M, Leroy J, Wu HS, Marescaux J. Mentored trainees obtain comparable operative results to experts in complex laparoscopic colorectal surgery. Int J Colorectal Dis 2012; 27:65-69. [PMID: 21861072 DOI: 10.1007/s00384-011-1290-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2011] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study is to evaluate the impact of an expert monitoring on the quality and results of laparoscopic reversal of Hartmann's procedure (LRHP) performed by trainee surgeons by comparing their results to the expert's outcomes. METHODS Forty-two LRHP were performed between 2000 and 2008 following a step-by-step, standardised, full laparoscopic procedure. Patients operated upon by a senior surgeon were compared to patients operated upon by trainee surgeons while being mentored by the senior surgeon. Operative time, conversion, complications and post-operative outcome were measured. RESULTS Each group included 21 patients. All patients underwent LRHP successfully. Two procedures were converted. No significant difference was observed between the expert and the trainees: operative time, 132 min (SD ± 50) vs. 131 min (SD ± 47) and complications (2-14%), 4 vs. 2. Three complications required re-operation, and three other were treated medically, including one dilatation of an anastomosis. Post-operative outcomes were comparable (oral intake, 3 vs. 2 days; post-operative hospital stay, 6 vs. 7.5 days); no mortality occurred. CONCLUSIONS Standardisation simplifies this difficult laparoscopic procedure and offers the same outcome whether it is performed by an expert or by mentored trainees. The complications were comparable to those occurring at experienced centres (anastomotic leak or stricture, ureteral injury, re-operation). The expert mentoring does not prevent all complications but can solve intra-operative technical problems, thus improving the trainee's confidence. Mentoring should be promoted as it can be performed locally or remotely using modern interactive technology.
Collapse
Affiliation(s)
- Federico Costantino
- IRCAD-EITS Institute, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France
| | | | | | | | | | | | | |
Collapse
|
21
|
Leroy J, Costantino F, Cahill RA, D'Agostino J, Wu WHS, Mutter D, Marescaux J. Technical aspects and outcome of a standardized full laparoscopic approach to the reversal of Hartmann's procedure in a teaching centre. Colorectal Dis 2011; 13:1058-1065. [PMID: 20718831 DOI: 10.1111/j.1463-1318.2010.02389.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM Laparoscopic reversal of Hartmann's procedure is technically demanding. We evaluated the technical aspects and outcome of a standardized approach in a single centre and examined the feasibility of including this into training curricula. METHOD The procedure entails a laparoscopy for adhesiolysis and identification and mobilization of the rectal stump. Mobilization of the splenic flexure is performed if necessary, and a colorectal anastomosis is fashioned after introduction of the stapler anvil via the colostomy with intra-abdominal positioning and delivery into the proximal colonic segment to be anastomosed. The stoma is excised as the last step in the operation. RESULTS Forty-two patients underwent the procedure over an 8-year period with either an expert (n=21) or trainee under expert mentorship (n=21) as first operator. Intra-operative data and postoperative outcomes were evaluated by retrospective review of clinical charts and theatre records. There was a 9.5% conversion rate and 0% mortality. One patient suffered a ureteric injury, while postoperative surgical complications occurred in 7 patients (including one clinical anastomotic leakage). The mean operative time was 117 min. There was no significant difference in intra operative technical parameters or postoperative clinical consequences between procedures performed by a trained surgeon or by a trainee under mentorship. CONCLUSION Adherence to a standardized operative protocol and expert mentorship allows this technically demanding operation to be associated with low conversion and complication rates. The absence of any difference between procedures performed by a trainee or trained surgeon suggests that the operation can be included in training programmes for laparoscopic surgery.
Collapse
Affiliation(s)
- J Leroy
- IRCAD, University Hospital of Strasbourg, Strasbourg, France.
| | | | | | | | | | | | | |
Collapse
|
22
|
Lee JK, Stein SL. Laparoscopic Management of Diverticular Disease. SEMINARS IN COLON AND RECTAL SURGERY 2011. [DOI: 10.1053/j.scrs.2011.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
23
|
Abstract
BACKGROUND Single-port access offers cosmetic advantages in addition to the well-recognized benefits of standard multiport laparoscopic surgery, and can be performed with the use of standard straight instruments. We describe a technique of single-port access reversal of Hartmann colostomy by use of the colostomy site for access. METHODS After routine skin preparation and laparoscopic setup, the colostomy is mobilized from its mucocutaneous border, and the anvil of a circular stapler is secured to the distal lumen. By the use of a GelPoint system with 3 or 4 trocars, the intra-abdominal adhesions are divided and the splenic flexure is mobilized to achieve sufficient access to the abdominal and pelvic cavities and proximal colonic mobility. The rectal stump is mobilized to the mid rectum, starting from the posterior mesorectal fascia around to the anterior rectal wall. A tension-free colorectal anastomosis is secured with a standard circular stapling device inserted transanally, and leak tested. The colostomy wound is closed in standard fashion. RESULTS Five patients underwent single-port access reversal of Hartmann resection (4 diverticular perforations and 1 pT3N0 colon cancer), with a mean operating time of 155 (range, 137-187) minutes and a median length of stay of 3 (range, 2-11) days. There were no conversions, major surgical morbidity, or deaths. CONCLUSION Single-port access reversal of Hartmann colostomy through the stoma site is safe, and it offers additional cosmetic advantages with no apparent additional morbidity in comparison with standard multiport surgery.
Collapse
|
24
|
Huynh H, Trottier DC, Soto CM, Moloo H, Poulin EC, Mamazza J, Boushey RP. Laparoscopic colostomy reversal after a Hartmann procedure: a prospective series, literature review and an argument against laparotomy as the primary approach. Can J Surg 2011; 54:133-7. [PMID: 21251422 DOI: 10.1503/cjs.013510] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Open restoration of bowel continuity after a Hartmann procedure has been associated with significant morbidity, including anastomotic leak, incisional hernia, wound infections and inability to re-establish intestinal continuity. Few studies have examined the role of laparoscopy in performing a Hartmann reversal. The aim of this study was to review our laparoscopic Hartmann reversal (LHR) experience with an emphasis on intra- and postoperative adverse events. METHODS A prospectively collected laparoscopic colorectal database involving 3 surgeons in 4 academic centres between 1991 and 2008 was reviewed. Factors evaluated were patient demographics, diagnosis, duration of surgery, intra- and postoperative complications, recovery of bowel function and length of stay in hospital. RESULTS Twenty-eight consecutive patients (13 men, 15 women) with a mean age of 61.1 (standard deviation [SD] 15.3) years and a mean weight of 72.3 (SD 20.1) kg underwent LHR. The diagnosis at initial surgery was complicated diverticulitis in 19 patients (67.9%), cancer in 6 patients (21.4%) and "other" in 3 patients (10.7%). The median duration of surgery was 166.2 (SD 74.4) minutes. There were no conversions. There was 1 major intraoperative complication (bleeding; 3.6%). There were 3 postoperative complications (10.7%): 1 abscess, 1 prolonged ileus and 1 wound hematoma. Only 1 patient with an abscess required readmission. There were no observed clinical anastomotic leaks. All patients underwent successful reanastomosis. The median time to return of bowel function was 4 (interquartile range [IQR] 3-4) days. The median length of stay in hospital was 5 (IQR 3-6) days. There was no mortality. CONCLUSION Laparoscopic colostomy reversal after a Hartmann procedure is safe and feasible in experienced hands. It is associated with low morbidity, quick return of bowel function and short stay in hospital.
Collapse
Affiliation(s)
- Hai Huynh
- The Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ont., Canada
| | | | | | | | | | | | | |
Collapse
|
25
|
[Laparoscopic approach for intestinal passage reconstruction after Hartmann's operation: experience with 30 patients]. Cir Esp 2011; 88:314-8. [PMID: 20889148 DOI: 10.1016/j.ciresp.2010.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2010] [Revised: 08/04/2010] [Accepted: 08/20/2010] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Intestinal passage reconstruction after Hartmann's (PRH) operation is associated with a high morbidity and mortality of about 1%. Despite the increasing use of laparoscopy as an alternative in PRH, there is a lack of patient series at international level. PATIENTS AND METHODS The prospective series of patients subjected to (PRH) by laparoscopy was analysed using the demographic parameters, ASA classification, reason for primary surgery, time between initial surgery and reconstruction, operation time, conversion to open surgery, bowel rest recovery time, complications, hospital stay and follow up. RESULTS A total of 30 patients with a mean age of 61.5 ± 13 years were operated on using laparoscopy. The ASA classification was 1.8 ± 0.3 the BMI was 26.1 ± 2 Kg/m(2). A total of 63% were admitted due to complicated Hinchley III or IV acute diverticulitis. The interval between initial surgery and the passage reconstruction was 7.1 ± 2 months. Conversion to open surgery was necessary in three cases. The mean intestinal passage recovery was 2.1 ± 1 days and the hospital stay was 5.6 ± 1 days. The long-term complications were one mechanic ileum due to bridles and one case of anastomotic stenosis. CONCLUSIONS The post-Hartmann laparoscopic passage reconstruction is associated with a short intestinal motility recovery time, as well as a less prolonged hospital stay compared to an open surgery series. Randomised studies are needed to determine whether laparoscopic reconstruction is superior to the conventional technique.
Collapse
|
26
|
Siddiqui MRS, Sajid MS, Baig MK. Open vs laparoscopic approach for reversal of Hartmann's procedure: a systematic review. Colorectal Dis 2010; 12:733-41. [PMID: 20649805 DOI: 10.1111/j.1463-1318.2009.01892.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM A meta-analysis of published literature comparing open vs laparoscopic Hartmann's reversal. METHOD MEDLINE, EMBASE, CINAHL, PubMed and the Cochrane databases were searched from January 1993 to August 2008. The bibliography of selected trials was scrutinized and relevant references obtained. A systematic review was performed to obtain a summative outcome. RESULTS Eight comparative studies involving 450 patients were analysed. One hundred and ninety-three patients were in the laparoscopic and 257 in the open group. Laparoscopic reversal has a significantly reduced complication rate (z = -2.92, P < 0.01), intra-operative blood loss (z = -7.34, P < 0.001) and hospital stay (z = -3.16, P < 0.01) compared with the conventional approach. No difference in leak rates was found. CONCLUSION Laparoscopic reversal of Hartmann's procedure is safe, has fewer complications and shorter hospital stays. This approach may be considered for reversal, however, randomized controlled trials are required to strengthen the evidence.
Collapse
Affiliation(s)
- M R S Siddiqui
- Department of Colorectal Surgery, Worthing Hospital, Worthing, West Sussex BN11 2DH, UK.
| | | | | |
Collapse
|
27
|
Abstract
INTRODUCTION Restoration of intestinal continuity following Hartmann procedure is an operation associated with a lengthy stay in hospital, protracted convalescence, and a high morbidity rate. With the aim of using the advantages of minimally invasive surgery, such as rapid mobilization, less postoperative pain, early restoration of bowel function, and a rapid return to a normal diet, and reduced morbidity, the laparoscopic modality was employed. The objective of the present study was to investigate the usefulness of laparoscopic restoration of intestinal continuity following Hartmann procedure. METHOD A total of 71 patients who, in the period between 1995 and 2005 within the framework of the prospective multicenter study "Laparoscopic Colorectal Surgery Study Group," underwent a laparoscopically assisted restoration of bowel continuity following Hartmann procedure, were investigated. RESULTS In 62 patients (87%), the laparoscopic procedure was completed as planned, whereas 9 cases had to be converted to open surgery-mostly on account of massive intra-abdominal adhesions. The 39 male (55%) and 32 female (45%) patients had an average body mass index of 25 (range, 19 to 38), a height of 168 cm (range, 150 to 190 cm), and a weight of 72 kg (range, 49 to 103 kg). Mean operating time was 164 min (range, 60 to 410 min) and the intraoperative blood loss 196 mL (range, 10 to 1000 mL). Five patients (7%) received packed red cells. In all, 85.9% of the procedures (n=61) were free of complications. The most common intraoperative complications were injuries to the bowel and problems with the anastomosis (dehiscence, difficult stapling), each occurring in 5.6% of the cases (n=4). Intraoperative lesions to the ureters (0%), the bladder (n=1/1.4%), and blood vessels (n=1/1.4%) played a numerically subordinate role. Purely parenteral nutrition was applied up to the third postoperative day (range, 0 to seventh postoperative day). In those patients who were able to take a liquid meal on the third postoperative day (range, first to eighth postoperative day), enteral nutrition was initiated on the fifth postoperative day (range, second to tenth postoperative day). On average, bowel movements were restored on the fourth postoperative day (range, second to ninth postoperative day). Patients in whom a bladder catheter was placed for the operation had it removed on the third postoperative day (range, first to twelfth postoperative day) and had normal urination thereafter. In Hartmann procedure, patients without such a catheter, normal urination was possible from postoperative day 1 onward (range, 0 to second postoperative day). Postoperative complications included hematomas/abscesses (n=3/4.2%), transit disorders (n=2/2.8%), surgery-requiring ileus (n=2/2.8%), cardiopulmonary complications (n=1/1.4%), and surgery-requiring hemorrhage (n=1/1.4%), with other complications accounting for 4.2% (n=3). The median hospital stay was 11 days (range, 5 to 35 d); the mortality rate was 1.4% (n=1). CONCLUSIONS Reversal of Hartmann procedure employing the laparoscopic modality is compatible with acceptable morbidity and mortality rates. The elevated conversion rate is a reflection of the fact that the operation is technically demanding.
Collapse
|
28
|
Haughn C, Ju B, Uchal M, Arnaud JP, Reed JF, Bergamaschi R. Complication rates after Hartmann's reversal: open vs. laparoscopic approach. Dis Colon Rectum 2008; 51:1232-6. [PMID: 18512101 DOI: 10.1007/s10350-008-9264-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Revised: 11/07/2007] [Accepted: 11/18/2007] [Indexed: 12/15/2022]
Abstract
PURPOSE This study was performed to compare open Hartmann's reversal to laparoscopic Hartmann's reversal with regard to complication, readmission, and reoperation rates. METHODS Data of patients who underwent open Hartmann's reversal or laparoscopic Hartmann's reversal between 1998 and 2004 at two institutions were collected. End points were complications in the hospital or after discharge, readmission to the hospital, and reoperation within 6 months after initial surgery. RESULTS Sixty-one open Hartmann's reversal and 61 laparoscopic Hartmann's reversal patients were well matched except for American Society of Anesthesiology grade (1.9 vs. 1.6; P = 0.008), timing of Hartmann's procedure (14 vs. 6 months; P = 0.001), operation time (210 vs. 154 minutes; P = 0.001), and estimated blood loss (363 vs. 254 ml; P = 0.01). Thirty-day complication rates did not differ (18 vs. 13 percent). At 6 month follow-up, open Hartmann's reversal patients had increased complication (16.4 vs. 3.3 percent; P = 0.015) and reoperation (13.1 vs. 3.3 percent; P = 0.048) rates but the same readmission rates (16.4 percent). CONCLUSIONS Compared with open Hartmann's reversal, 6 month complication and reoperation rates were lower in laparoscopic Hartmann's reversal patients. Most of the six-month complications and reoperations in open Hartmann's reversal were abdominal wall-related. Readmission rates were similar, but reasons for readmission were surgical in open Hartmann's reversal and medical in laparoscopic Hartmann's reversal.
Collapse
Affiliation(s)
- Christopher Haughn
- Department of Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | | |
Collapse
|
29
|
Mazeh H, Greenstein AJ, Swedish K, Nguyen SQ, Lipskar A, Weber KJ, Chin EH, Divino CM. Laparoscopic and open reversal of Hartmann's procedure--a comparative retrospective analysis. Surg Endosc 2008; 23:496-502. [PMID: 18633672 DOI: 10.1007/s00464-008-0052-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 06/05/2008] [Accepted: 06/18/2008] [Indexed: 12/22/2022]
Abstract
BACKGROUND 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. RESULTS 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). CONCLUSIONS 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.
Collapse
Affiliation(s)
- Haggi Mazeh
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
Traditionally, stoma creation and end stoma reversal have been performed via a laparotomy incision. However, in many situations, stoma construction may be safely performed in a minimally invasive nature. This may include a trephine, laparoscopic, or combined approach. Furthermore, Hartmann's colostomy reversal, a procedure traditionally associated with substantial morbidity, may also be performed laparoscopically. The authors briefly review patient selection, preparation, and indications, and focus primarily on surgical techniques and results of minimally invasive stoma creation and Hartmann's reversal.
Collapse
Affiliation(s)
- Michael D Hellinger
- Department of Surgery, Mount Sinai Medical Center, Miami Beach, FL 33140, USA.
| | | |
Collapse
|
31
|
Reversal of Hartmann's procedure: a high-risk operation? Surgery 2007; 142:598-606; discussion 606-7. [PMID: 17950354 DOI: 10.1016/j.surg.2007.08.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 08/08/2007] [Accepted: 08/18/2007] [Indexed: 12/31/2022]
Abstract
BACKGROUND Patients who undergo Hartmann's procedure often do not have their colostomy closed based on the perceived risk of the operation. This study evaluated the outcome of reversal of Hartmann's procedure based on preoperative risk factors. METHODS We retrospectively reviewed adult patients who underwent reversal of Hartmann's procedure at our tertiary referral institution. Patient outcomes were compared based on identified risk factors (age >60 years, American Society of Anesthesiologists [ASA] score >2, and >2 preoperative comorbidities). RESULTS One-hundred thirteen patients were included. Forty-four patients (39%) had an ASA score of >or=3. The mean hospital duration of stay was 6.8 days. There were 28 (25%) postoperative complications and no mortality. Patients >60 years old had significantly longer LOS compared with the rest of the group (P = .02). There were no differences in outcomes between groups based on ASA score or the presence of multiple preoperative comorbidities. An albumin level of <3.5 was the only significant predictor of postoperative complications (P = .04). CONCLUSIONS The reversal of Hartmann's operation appears to be a safe operation with acceptable morbidity rates and can be considered in patients, including those with significant operative risk factors.
Collapse
|
32
|
Rao PKD, Clements D, Davies MM, Torkington J. Comments on: Laparoscopically assisted reversal of Hartmann’s procedure. Surg Endosc 2007; 21:1036. [PMID: 17440779 DOI: 10.1007/s00464-007-9375-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Accepted: 02/24/2007] [Indexed: 11/28/2022]
|