Jean-Sébastien Trépanier1,2, María Clara Arroyave1,3, Raquel Bravo1, Marta Jiménez-Toscano1, Francisco B DeLacy1, María Fernandez-Hevia1, Antonio M Lacy4. 1. Department Barcelona, Gastrointestinal Surgery, Hospital Clínic de Barcelona, Carrer de Villaroel 170, 08036, Barcelona, Catalonia, Spain. 2. Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Assomption, Montreal, Quebec, H1T 2M4, Canada. 3. Clínica Somer, Calle 38 #35A-54, Rionegro, Antioquia, Colombia. 4. Department Barcelona, Gastrointestinal Surgery, Hospital Clínic de Barcelona, Carrer de Villaroel 170, 08036, Barcelona, Catalonia, Spain. alacy@clinic.ub.es.
Abstract
INTRODUCTION: Restoration of intestinal continuity after Hartmann's procedure is a technically difficult surgery associated with significant morbidity and mortality. This study presents the short-term results of a new approach: a transanal Hartmann's colostomy reversal assisted by laparoscopy. METHOD: This is a retrospective analysis of data collected in one tertiary hospital, from October 2013 to November 2015. RESULTS: During the study period, there were ten cases of transanal Hartmann's reversal. Reasons for Hartmann's procedure were: complicated diverticulitis (4), anastomotic leak (3), and recto-sigmoid cancer (3). Rectal stump length was 10.4 ± 4.5 cm. Reconstruction was achieved in all patients. One low colorectal anastomosis was hand-sewn, the other 9 were stapled. Mean operative time was 204 ± 65 min. Diverting loop ileostomies were created in five patients and all were closed during the following year. One case required hand-assistance but there was no conversion to open surgery. Iatrogenic laparoscopic enterotomies occurred in four patients and all were repaired primarily without consequences. Three patients had a total of four post-operative complications: ileus (2), abdominal abscess and wound infection (1). None required reoperation. Mean length of stay was 7.2 ± 4.3 days. One required readmission. CONCLUSION: A transanal Hartmann's reversal assisted by laparoscopy is a new approach for a difficult surgery. It has the potential to be an additional tool in the case of hostile pelvises or with a rectal stump difficult to identify. The surgery remains challenging and indications need to be clarified.
INTRODUCTION: Restoration of intestinal continuity after Hartmann's procedure is a technically difficult surgery associated with significant morbidity and mortality. This study presents the short-term results of a new approach: a transanal Hartmann's colostomy reversal assisted by laparoscopy. METHOD: This is a retrospective analysis of data collected in one tertiary hospital, from October 2013 to November 2015. RESULTS: During the study period, there were ten cases of transanal Hartmann's reversal. Reasons for Hartmann's procedure were: complicated diverticulitis (4), anastomotic leak (3), and recto-sigmoid cancer (3). Rectal stump length was 10.4 ± 4.5 cm. Reconstruction was achieved in all patients. One low colorectal anastomosis was hand-sewn, the other 9 were stapled. Mean operative time was 204 ± 65 min. Diverting loop ileostomies were created in five patients and all were closed during the following year. One case required hand-assistance but there was no conversion to open surgery. Iatrogenic laparoscopic enterotomies occurred in four patients and all were repaired primarily without consequences. Three patients had a total of four post-operative complications: ileus (2), abdominal abscess and wound infection (1). None required reoperation. Mean length of stay was 7.2 ± 4.3 days. One required readmission. CONCLUSION: A transanal Hartmann's reversal assisted by laparoscopy is a new approach for a difficult surgery. It has the potential to be an additional tool in the case of hostile pelvises or with a rectal stump difficult to identify. The surgery remains challenging and indications need to be clarified.
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