Reversal of Hartmann's procedure in patients with diverticular disease

• Published in: Hirurgija (Moskva) no. 8; p. 54
• Main Authors: Goncharov, A L, Chicherina, M A, Aslanyan, A S, Muratov, I I, Gallyamov, E A
• Format: Journal Article
• Language: English; Russian
• Published: Russia (Federation) 2023
• Subjects: Anastomosis, Surgical - adverse effects; Anastomosis, Surgical - methods; Anastomotic Leak; Colostomy - adverse effects; Colostomy - methods; Diverticular Diseases - complications; Diverticular Diseases - diagnosis; Diverticular Diseases - surgery; Humans; Laparoscopy - adverse effects; Laparoscopy - methods; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Retrospective Studies; Treatment Outcome; laparoscopy; Hartmann’s reversal; diverticular disease
• ISSN: 0023-1207
• DOI: 10.17116/hirurgia202308154

To analyze intraoperative and early postoperative results of open and laparoscopic reversal of Hartmann's (HR) procedure in patients with diverticular disease.
A single-center retrospective non-randomized study included 31 patients with complicated form of diverticular disease between 2018 and 2022. Patients underwent reversal of Hartmann's procedure (laparoscopic surgery - 19, laparotomy - 12).
Mean time of laparoscopy and open surgery was 202±36.7 and 223±41 min, respectively. There were no intraoperative complications in both groups and conversions of laparoscopic reversal of Hartmann's procedure. No preventive stoma was required. Mean postoperative hospital-stay was 7.6±3.2 and 9.5±4.6 days, respectively. Overall incidence of postoperative complications was 32.2% (
=10), i.e. 4 (21%) and 6 (50%) patients in both groups, respectively. Anastomotic leakage occurred in one patient after open surgery.
In our sample, incidence of complications was low after reversal of Hartmann's procedure in patients with complicated diverticular disease. There was 1 (3.2%) patient with anastomotic leakage, and no temporary stoma was formed. In patients who underwent laparoscopic Hartmann's procedure at the first stage and selected patients after open surgeries, laparoscopic reversal procedures were accompanied by no conversions. There were favorable results typical for minimally invasive surgery. Selection criteria for laparoscopic access are discussable. Large-scale studies including randomized trials are needed to verify selection criteria for minimally invasive reversal of Hartmann's procedure and demonstrate its advantages over open surgery.