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Transanal Hartmann reversal: a new technique
R Bravo1, M Fernández-Hevia2, M Jiménez-Toscano2
1Gastrointestinal Surgery Service, Hospital Clinic Barcelona, Carrer Villarroel 170, 08036, Barcelona, Spain. rbravo@clinic.ub.es.
Surgical Endoscopy
|October 2, 2015
Summary
Restoring colonic continuity after a Hartmann procedure can be challenging. A combined laparoscopic and transanal approach offers a safe and feasible technique for Hartmann reversal, potentially improving outcomes.
Area of Science:
- Colorectal Surgery
- Minimally Invasive Surgery
- Surgical Innovation
Background:
- The Hartmann procedure, involving sigmoidectomy and end colostomy, can lead to stoma-related complications and reduced quality of life.
- Restoration of colonic continuity is often considered to mitigate these issues.
- Traditional open reversal is associated with significant morbidity and mortality, prompting interest in laparoscopic techniques.
Purpose of the Study:
- To evaluate a novel combined laparoscopic and transanal approach for Hartmann reversal.
- To assess the safety and feasibility of this minimally invasive technique.
Main Methods:
- Patients undergoing Hartmann reversal with an end colostomy were selected.
- A simultaneous laparoscopic and transanal approach was employed using single-port devices.
- Transanal resection of the stapler line and laparoscopic dissection were performed, followed by laparoscopic-controlled end-to-end anastomosis.
Main Results:
- Dissection of the rectal stump may be improved with this technique.
- The combined approach may be associated with shorter operative times, similar to rectal cancer surgery.
Conclusions:
- The combined laparoscopic and transanal approach appears to be a safe and feasible technique for Hartmann reversal.
- Further studies are needed to fully establish the long-term benefits and outcomes of this innovative surgical method.