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Laparoscopic reversal of Hartmann's procedure: safety and feasibility
Daniel C K Ng1, Salvatore Guarino, Steven L C Yau
1Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong and Department of Surgery, Hong Kong Sanitorium Hospital.
Aims:
The present study aimed to compare the surgical outcomes of patients receiving laparoscopic reversal of Hartmann's procedure (RHP) with those receiving open surgery.
Methods:
Records of all patients with RHP performed in our unit (including laparoscopic and open surgery) between 2000 and 2012 were retrieved. Data were retrospectively reviewed and compared.
Results:
Eighty-two RHPs were performed between 2000 and 2012. Thirty-five were performed with an open approach and 47 with a laparoscopic approach. Conversion rate was 28% in the laparoscopic group. There was no difference, between the two groups, in operation time or blood loss. The median length of stay was significantly shorter in the laparoscopic group (12 vs 14 days, P = 0.002) and fewer patients in the laparoscopic group had complications with post-operative paralytic ileus (2 vs 17%, P = 0.038). None of the patients in the laparoscopic group developed incisional hernia at the conclusion of follow-up, as opposed to five in the open group (0 vs 14%, P = 0.012).
Conclusion:
Laparoscopic RHP is safe and feasible, with more favorable surgical outcomes, when compared with open surgery. Conversion rate is acceptable. It should be the technique of choice for patients undergoing RHP.
