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[Is it possible to perform a laparoscopic assisted Hartmann's procedure and a subsequent laparoscopically assisted
1Helios-Klinikum Aue, Klinik für Viszeral- und Gefäßchirurgie, Aue, Deutschland. roland.albrecht@helioskliniken.de
Abstract:
Surgery of complicated sigmoid diverticulitis should be as gentle as possible. Serious time pressure, unpredictable operation fields and unprepared bowel determine the surgical strategy. Hence, we examine whether minimal invasive surgery (MIS) (i. e., Hartmann procedure) is suited for emergency conditions in selected patients. Furthermore, the objective of the study was to -assess the feasibility of the reversal of Hartmann procedure in appropriate patients after a preceding classical or laparoscopic intervention. -Between 2005 and 2009 128 patients with sigma diverticulitis were operated, 72 patients of them with complicated sigmoid diverticulitis (peritonitis, haemorrhage, ileus, perforation), The classical Hartmann procedure was performed in 45 (35 %) patients, 39 of them being treated within 24 hours. The laparoscopically assisted Hartmann procedure was realised in 15 patients and could be successfully completed in 13 cases. The cor-responding mortality rate was 0 %. A Hartmann reversal could be performed in 26 patients (58 %). A laparoscopic approach was chosen in 16 patients and could be successfully completed in 14 cases. 12 patients were operated with classical Hartmann reversal. The respective mortality rates in both groups were 0 %. We therefore conclude that in cases of peritonitis due to sigmoid diverticulitis laparoscopic surgery, like laparoscopically assisted Hartmann procedure and a subsequent laparoscopically assisted reversal could be recommended in selected patients.
Insights
Minimal invasive surgery (MIS) for complicated sigmoid diverticulitis, including the Hartmann procedure, is feasible in emergencies. Laparoscopic approaches for both the initial procedure and its reversal show promising results with zero mortality.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Complicated sigmoid diverticulitis presents surgical challenges due to time pressure and unpredictable conditions.
- The Hartmann procedure is a common surgical approach for severe cases.
Purpose of the Study:
- To evaluate the suitability of minimally invasive surgery (MIS), specifically the Hartmann procedure, for emergency sigmoid diverticulitis.
- To assess the feasibility of reversing the Hartmann procedure after initial laparoscopic or open surgery.
Main Methods:
- Retrospective analysis of 128 sigmoid diverticulitis patients operated between 2005-2009.
- Comparison of classical versus laparoscopically assisted Hartmann procedures and their reversals.
- Data collection on patient outcomes, including mortality rates.
Main Results:
- 72 patients had complicated sigmoid diverticulitis; 45 underwent classical Hartmann, 15 laparoscopically assisted.
- Laparoscopic Hartmann procedure was successful in 13 of 15 patients with 0% mortality.
- Hartmann reversal was successful in 26 patients (58%), with 0% mortality for both laparoscopic and classical approaches.
Conclusions:
- Laparoscopic surgery, including the laparoscopically assisted Hartmann procedure and subsequent reversal, is a viable option for selected patients with sigmoid diverticulitis peritonitis.
- MIS offers a safe and effective alternative in emergency settings for complicated sigmoid diverticulitis.
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