Annals of Coloproctology

The Korean Society of Coloproctology (대한대장항문학회)
권호 표지
DOI QR코드

DOI QR Code

Efficacy and Safety of Laparoscopic Hartmann Colostomy Reversal

  • Park, Won (Department of Surgery, Wonkwang University School of Medicine) ;
  • Park, Won Cheol (Department of Surgery, Wonkwang University School of Medicine) ;
  • Kim, Keun Young (Department of Surgery, Wonkwang University School of Medicine) ;
  • Lee, Seok Youn (Department of Surgery, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine)
  • Received : 2018.06.14
  • Accepted : 2018.09.07
  • Published : 2018.12.31
⟨ Previous Next ⟩

Abstract

Purpose: Hartmann operation is widely recognized as a useful procedure, especially in emergencies involving the rectosigmoid colon. One of the surgeon's foremost concerns after Hartmann operation is future colostomy reversal, as colostomy reversal after a Hartmann procedure is associated with relatively high morbidity and mortality. Laparoscopic surgical techniques continue to prove useful for an ever-increasing variety of indications. We analyzed the outcomes of laparoscopic Hartmann colostomy reversals at our center. Methods: We retrospectively analyzed the hospital records of 170 patients who had undergone Hartmann operation between January 2010 and June 2017 at Wonkwang University Hospital. Among 68 Hartmann colostomy reversals, we evaluated and compared the outcomes of 3 groups of patients: 29 patients in the open colostomy reversal group (OG) who had undergone laparotomies for Hartmann reversals, 19 patients in the conversion group (CG) whose laparoscopic procedures had required conversion to a laparotomy, and 20 patients in the laparoscopy group (LG). Results: The overall reversal rate for Hartmann colostomies was 40.5% during this time period. The duration of hospital stay was significantly shorter among LG patients ($10.15{\pm}2.94days$) than among OG patients ($16{\pm}9.5days$). The overall complication rate among OG patients was higher than that among LG patients (adjusted odds ratio, 8.78; P = 0.01). The most common complication was postoperative ileus (19.1%). Conclusion: If no contraindications to laparoscopy exist, surgeons should favor a laparoscopic reversal of Hartmann operation over an open reversal.

Keywords

Acknowledgement

Supported by : Wonkwang University

References

  1. Hartmann H. Note sur un procede nouveau d'extirpation des cancers de la partie terminale du colon. Bull Mem Soc Chir Paris 1923;49:1474-7.
  2. Cellini C, Deeb AP, Sharma A, Monson JR, Fleming FJ. Association between operative approach and complications in patients undergoing Hartmann's reversal. Br J Surg 2013;100:1094-9. https://doi.org/10.1002/bjs.9153
  3. 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. https://doi.org/10.1016/j.ijsu.2013.06.006
  4. Park JM, Chi KC. Laparoscopic reversal of Hartmann's procedure. J Korean Surg Soc 2012;82:256-60. https://doi.org/10.4174/jkss.2012.82.4.256
  5. Walklett CL, Yeomans NP. A retrospective case note review of laparoscopic versus open reversal of Hartmann's procedure. Ann R Coll Surg Engl 2014;96:539-42. https://doi.org/10.1308/003588414X14055925058238
  6. Ng DC, Guarino S, Yau SL, Fok BK, Cheung HY, Li MK, et al. Laparoscopic reversal of Hartmann's procedure: safety and feasibility. Gastroenterol Rep (Oxf) 2013;1:149-52. https://doi.org/10.1093/gastro/got018
  7. Toro A, Ardiri A, Mannino M, Politi A, Di Stefano A, Aftab Z, et al. Laparoscopic reversal of Hartmann's procedure: state of the art 20 years after the first reported case. Gastroenterol Res Pract 2014;2014:530140.
  8. Melkonian E, Heine C, Contreras D, Rodriguez M, Opazo P, Silva A, et al. Reversal of the Hartmann's procedure: a comparative study of laparoscopic versus open surgery. J Minim Access Surg 2017;13:47-50. https://doi.org/10.4103/0972-9941.181329
  9. Diamond MP, Wexner SD, diZereg GS, Korell M, Zmora O, Van Goor H, et al. Adhesion prevention and reduction: current status and future recommendations of a multinational interdisciplinary consensus conference. Surg Innov 2010;17:183-8. https://doi.org/10.1177/1553350610379869
  10. Hackethal A, Sick C, Szalay G, Puntambekar S, Joseph K, Langde S, et al. Intra-abdominal adhesion formation: does surgical approach matter? Questionnaire survey of South Asian surgeons and literature review. J Obstet Gynaecol Res 2011;37:1382-90. https://doi.org/10.1111/j.1447-0756.2011.01543.x
  11. Choi BJ, Jeong WJ, Kim YK, Kim SJ, Lee SC. Single-port laparoscopic reversal of Hartmann's procedure via the colostomy site. Int J Surg 2015;14:33-7. https://doi.org/10.1016/j.ijsu.2014.12.026

Cited by

  1. Emergency Hartmann’s Procedure and its Reversal: A Totally Laparoscopic 2-Step Surgery for the Treatment of Hinchey III and IV Diverticulitis vol.26, pp.6, 2018, https://doi.org/10.1177/1553350619874272
  2. A comparative study between open versus laparoscopic Hartmann reversal : A single-center experience and analysis vol.100, pp.47, 2021, https://doi.org/10.1097/md.0000000000027976
  3. Laparoscopic Versus Open Hartmann Reversal: A Case-Control Study vol.2021, pp.None, 2021, https://doi.org/10.1155/2021/4547537
  4. Effects of Laparoscopic Hartmann Reversal on Short-term Operative Outcomes Among Vietnamese Patients vol.41, pp.2, 2018, https://doi.org/10.1055/s-0041-1730013
  5. A Case of Laparoscopic Hartmann's Procedure Followed by Laparoscopic Reversal for Perforated Diverticulitis vol.75, pp.1, 2018, https://doi.org/10.3862/jcoloproctology.75.36