Laparoscopic versus open restoration of intestinal continuity after Hartmann procedure.

Background/aims: To present the initial experience with laparoscopic technique of restoration after Hartmann procedure compared to open surgery.

Methodology: All patients submitted to Hartmann procedure from 2003 to 2008 were considered. The following parameters were evaluated: age, gender, comorbidities, American Society of Anesthesiologists score, indication for the procedure, Hinchey scale, interval between Hartmann and reversal procedure, total operative time of Hartmann reversal, pain management, delay in renewal of peristalsis, start of alimentation, length of hospital stay, morbidity, and mortality.

Results: Six patients were divided into groups A and B. Patients in group A underwent open Hartmann reversal and patients in group B underwent laparoscopic Hartmann reversal. Mean operative time was 136,6 min for group A and 95,6 min for group B. Mean postoperative duration of nasogastric tube placement was 2 days for group A and 1 day for group B. Group B showed a earlier return of bowel function and earlier restart of alimentation. Group B had shorter length of stay. There was no mortality or morbidity.

Conclusions: Laparoscopic approach showed a shorter mean postoperative nasogastric tube time of placement and a shorter mean hospital stay, with faster resumption of bowel movements and early solid diet alimentation.