J Korean Surg Soc.  2012 Apr;82(4):256-260. 10.4174/jkss.2012.82.4.256.

Laparoscopic reversal of Hartmann's procedure

• Park JM
• Chi KC

• KMID: 1820075
• DOI: http://doi.org/10.4174/jkss.2012.82.4.256

Abstract

Reversal of Hartmann's procedure is a major surgical procedure associated with significant morbidity and mortality. Because of the difficulty of the procedure, laparoscopic reversal of Hartmann's procedure is not well established. We describe our experience with this laparoscopic procedure to assess its difficulty and safety. Five patients (4 men and 1 woman) underwent laparoscopic reversal of Hartmann's procedure (LRHP). The initial surgeries were performed to manage obstructive colorectal cancer for 4 patients, and rectovesical fistula for one patient. The procedure was laparoscopically completed for 4 patients. Conversion to open laparotomy was required for one patient, secondary to massive adhesion in lower abdomen. Transient ileostomies were made in 2 cases. Operative time ranged from 240 to 545 minutes. There was no operative mortality. LRHP can be performed safely by an experienced surgeon. However, it is still technically challenging and time consuming.

Keyword

Hartmann's procedure; Colostomy; Laparoscopy

MeSH Terms

Abdomen
Colorectal Neoplasms
Colostomy
Fistula
Humans
Ileostomy
Laparoscopy
Laparotomy
Male
Operative Time

Figure

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  Fig. 1 Laparoscopic view of the colostomy.

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  Fig. 2 Mobilization of the left colon and splenic flexure. S, spleen; C, descending colon.

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  Fig. 3 Laparoscopic view of rectal stump after pelvic adhesiolysis. R, rectal stump; SB, small bowel.

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  Fig. 4 End-to-end anastomosis with a circular stapling device. PC, proximal colon.

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