Reversal of Hartmann’s procedure utilizing single-port laparoscopy: an attractive alternative to laparotomy

• Published in: Surgical endoscopy Vol. 30; no. 5; pp. 1894 - 1901
• Main Authors: Clermonts, Stefan H. E. M., de Ruijter, Winanda M. J., van Loon, Yu-ting. T., Wasowicz, Dareczka K., Heisterkamp, Joos, Maring, John K., Zimmerman, David D. E.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-05-2016; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Aged; Aged, 80 and over; Anastomosis, Surgical - methods; Case-Control Studies; Colonic Neoplasms - surgery; Colostomy - methods; Diverticulitis; Female; Gastroenterology; Gynecology; Hepatology; Hernias; Humans; Intestinal Diseases - surgery; Intraoperative Complications - etiology; Laparoscopy; Laparoscopy - methods; Laparotomy; Length of Stay; Male; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Mortality; Operative Time; Ostomy; Postoperative Period; Proctology; Prospective Studies; Recovery (Medical); Rectum - surgery; Retrospective Studies; Surgery; Surgical anastomosis; Netherlands; Reversal; Restoration of continuity; Single port; Laparotomy; Hartmann’s procedure; Stoma site
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-015-4407-3

Background
Complications after restoration of intestinal continuity (RIC) following Hartmann’s procedure occur frequently and are often serious. These complications result in a reported morbidity of 4–30 % and a reported mortality of 10–14 %. Reducing the amount of surgical trauma accompanying abdominal access seems an attractive tool to reduce perioperative morbidity. This possibility is offered by single-port Hartmann’s reversal (SPHR) through the colostomy site.
Methods
The purpose of the present prospective study was to compare outcome of SPHR to a retrospectively collected historical control group of conventional open Hartmann’s reversal (OHR). All patients undergoing RIC between January 1, 2009, and January 1, 2014, were included in the present study. Operation time, morbidity and hospital stay were assessed. Postoperative surgical results of SPHR and OHR were the main outcome of the study.
Results
During the study period, 41 patients (M/F = 23:18; median age 58 (26–85) years) were included in the present study. Sixteen patients underwent OHR; 25 patients underwent SPHR. No mortality was observed in the present series. Median operation time was similar between groups [184 (29–377) vs. 153.5 (73–332) min]. Hospital stay was significantly shorter in the SPHR group [16 (4–74) vs. 4 (1–34) days,
p
 < 0.05]. The number of complications was significantly lower in the SPHR group (33 vs. 10,
p
 < 0.05); furthermore, significantly less patients had severe complications (Clavien–Dindo III or higher) in the SPHR group (7/33 vs. 1/10). Less wound-related complications occurred in the SPHR group (12 vs. 5,
p
 < 0.05).
Conclusion
This study confirms recent findings in the literature regarding the safety and feasibility of SPHR. SPHR seems to be an attractive alternative to OHR.