Surgical access through the stoma for laparoscopic reversal of Hartmann procedures

The rate of stoma reversal after Hartmann procedure is low, principally because of the technically demanding nature of the reversal procedure and preexisting comorbid disease frequently present in this patient group. Laparoscopic reversal of Hartmann procedure is an attractive alternative that can reduce perioperative morbidity but the feasibility of completing the procedure laparoscopically is often limited by extensive adhesion formation present after the initial open operation. We describe a technique for laparoscopic reversal of Hartmann procedure where the stoma is mobilized externally and a pneumoperitoneum established through this preexisting defect. Results for the first 7 cases show a median operative duration of 132 minutes and length of hospital stay of 6 days with no conversions. Insertion of the operating ports under direct vision and a more limited dissection to facilitate the anastomosis represents an alternative operative strategy that can be performed successfully, even in patients with comorbid disease.