Laparoscopic reversal of Hartmann's procedure: A single-center experience.

Introduction: Laparoscopic reversal of Hartmann's procedure (LHR) is considered a technically complex major surgical procedure. We present a retrospective analysis of a single-institution experience that assesses the treatment patterns and outcomes of patients who underwent LHR.

Materials And Surgical Technique: The study involved patients who underwent LHR between January 2004 and December 2017. All patients had previously undergone a conventional Hartmann's procedure for acute complicated diverticulitis or cancer. Patients were placed in a supine position with their legs spread apart and their left arm out to the side. Access into the abdomen was obtained through open laparoscopy, with a 12-mm trocar for a 30° laparascope inserted at the periumbilical site. We placed between three and five trocars depending on the level of operative difficulty encountered. The first surgical step was to dissect any existing adhesions, and then rectal mobilization was systematically performed to ensure the feasibility of the end-to-end anastomosis and to avoid bladder injury. The stoma was mobilized on the level of the abdominal wall and then freed from the fascia. We used a circular stapler to reestablish a tension-free anastomosis. Over 13 years, 20 patients underwent LHR. No patient required a temporary colostomy or ileostomy.

Discussion: Reversal of Hartmann's procedure involves high operative morbidity and mortality, and usually only relatively young and healthy patients are eligible for reversal. Our results are consistent with previously published literature regarding the advantages of LHR compared to the conventional technique. However, high-level evidence is still needed.