Laparoscopic Hartmann reversal after multiple open surgeries: surgical technique

Area of Science:

• Colorectal Surgery
• Minimally Invasive Surgery
• Surgical Standardization

Background:

• Hartmann's reversal after multiple laparotomies is technically demanding due to adhesions and altered anatomy.
• Minimally invasive approaches are often limited in complex reoperative cases, favoring open surgery.
• Standardized techniques are needed to improve safety and reproducibility in laparoscopic Hartmann reversals.

Purpose of the Study:

• To present a structured laparoscopic approach for Hartmann's reversal in patients with a history of multiple abdominal surgeries.
• To demonstrate the safety and feasibility of minimally invasive techniques in complex reoperative colorectal surgery.
• To enhance reproducibility and reduce morbidity in challenging Hartmann reversal procedures.

Main Methods:

• A standardized laparoscopic Hartmann reversal was performed using controlled peritoneal access and cold-blade adhesiolysis.
• A Knight-Griffen stapled anastomosis was created, with perfusion assessed by Indocyanine Green (ICG) fluorescence angiography.
• Anastomotic integrity was confirmed via air-leak testing and reinforced with barbed sutures; Enhanced Recovery After Surgery (ERAS) protocol was followed.

Main Results:

• The laparoscopic procedure was completed successfully without conversion to open surgery.
• No diverting stoma was required, and the postoperative course was uneventful.
• The patient was discharged on postoperative day three, indicating early recovery.

Conclusions:

• A structured laparoscopic approach can improve safety and reproducibility in complex Hartmann reversals.
• Minimally invasive techniques are viable even in challenging reoperative settings with appropriate standardization.
• Integration of technologies like ICG angiography may further standardize and enhance minimally invasive reversal surgery.