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Laparoscopic Hartmann Procedure-A Surgery That Still Saves Lives.

Costel Bradea1,2, Eugen Tarcoveanu1, Valentina Munteanu1

  • 1First Surgical Clinic, "St. Spiridon" Hospital Iasi, Independentei Str., No 1, 700111 Iasi, Romania.

Life (Basel, Switzerland)
|April 28, 2023
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Summary

The Hartmann procedure remains crucial for emergency surgeries. Laparoscopic Hartmann operations show reduced postoperative morbidity and mortality compared to open procedures, suggesting its potential as a standard approach.

Keywords:
Hartmann procedurecolorectal neoplasialaparoscopy

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Area of Science:

  • Colorectal Surgery
  • Surgical Oncology
  • Gastroenterology

Background:

  • The Hartmann procedure involves resecting the sigmoid colon and rectum, creating an end colostomy.
  • Indications include advanced rectosigmoid neoplasm, peritoneal sepsis, intestinal occlusion, and fragile colonic walls.
  • This procedure can be life-saving, even with potential stoma reversal failures.

Purpose of the Study:

  • To compare the outcomes of open versus laparoscopic approaches for the Hartmann procedure.
  • To evaluate the efficacy and safety of laparoscopic surgery in emergency colorectal interventions.

Main Methods:

  • Retrospective review of patient medical records for Hartmann procedures performed between January 1, 2016, and December 31, 2020.
  • Comparison of open and laparoscopic surgical approaches using univariate and multivariate statistical analyses.

Main Results:

  • 88 Hartmann operations were performed for intestinal/colonic occlusion, with 7.3% done laparoscopically.
  • Laparoscopic Hartmann procedures demonstrated lower postoperative morbidity and mortality compared to open procedures.
  • Pulmonary and cardiac morbidities correlated with general postoperative complications; peritonitis was linked to local complications, which were absent in the laparoscopic group.

Conclusions:

  • The Hartmann procedure is a vital emergency surgical intervention.
  • Laparoscopy shows promise as a standard approach for Hartmann procedures and reversals, despite current low adoption rates.
  • Barriers to laparoscopic adoption include complex colorectal cancer, patient's general condition, and reversal difficulties.