Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Oct;12(4):486-491.
doi: 10.1111/ases.12659. Epub 2018 Dec 13.

Laparoscopic reversal of Hartmann's procedure: A single-center experience

Resta Giuseppe  1 , Fabbri Nicolò Id  1 , Marino Serafino  1 , Giaccari Sara  1 , Tamburini Nicola  1 , Cavallesco Giorgio  1 , Anania Gabriele  1
Affiliations

Laparoscopic reversal of Hartmann's procedure: A single-center experience

Resta Giuseppe et al. Asian J Endosc Surg. 2019 Oct.

Erratum in

  • Corrigendum.
    [No authors listed] [No authors listed] Asian J Endosc Surg. 2022 Apr;15(2):480. doi: 10.1111/ases.13054. Asian J Endosc Surg. 2022. PMID: 35368154 No abstract available.

Abstract

Introduction: Laparoscopic reversal of Hartmann's procedure (LHR) is considered a technically complex major surgical procedure. We present a retrospective analysis of a single-institution experience that assesses the treatment patterns and outcomes of patients who underwent LHR.

Materials and surgical technique: The study involved patients who underwent LHR between January 2004 and December 2017. All patients had previously undergone a conventional Hartmann's procedure for acute complicated diverticulitis or cancer. Patients were placed in a supine position with their legs spread apart and their left arm out to the side. Access into the abdomen was obtained through open laparoscopy, with a 12-mm trocar for a 30° laparascope inserted at the periumbilical site. We placed between three and five trocars depending on the level of operative difficulty encountered. The first surgical step was to dissect any existing adhesions, and then rectal mobilization was systematically performed to ensure the feasibility of the end-to-end anastomosis and to avoid bladder injury. The stoma was mobilized on the level of the abdominal wall and then freed from the fascia. We used a circular stapler to reestablish a tension-free anastomosis. Over 13 years, 20 patients underwent LHR. No patient required a temporary colostomy or ileostomy.

Discussion: Reversal of Hartmann's procedure involves high operative morbidity and mortality, and usually only relatively young and healthy patients are eligible for reversal. Our results are consistent with previously published literature regarding the advantages of LHR compared to the conventional technique. However, high-level evidence is still needed.

Keywords: Hartmann's procedure; Hartmann's reversal; laparoscopy.

PubMed Disclaimer

References

    1. Hartmann H. New procedure for the removal of cancers of the terminal part of the pelvic colon. Nouveau procédé d'ablation des cancers de la partie terminale du colon pelvien Par M. Henri Hartmann, de Paris TRENTIÈME CONGRÈS DE CHIRURGIE STRASBOURG 1921: 411-413
    1. Boyden AM. "The surgical treatment of diverticulitis of the colon", Ann Surg 1950; 132(1): 94-109.
    1. Anderson CA, Fowler DL, White S et al. Laparoscopic colostomy closure. Surg Laparosc Endosc 1993; 3: 69-72.
    1. van de Wall BJM, Draaisma WA, Schouten ES et al. Conventional and laparoscopic reversal of the Hartmann procedure: A review of literature. J Gastrointest Surg 2010; 14: 743-752. https://doi.org/10.1007/ s11605-009-1084-3.
    1. Walklett CL & Yeomans NP. A retrospective case note review of laparoscopic versus open reversal of Hartmann's procedure. Ann R Coll Surg Engl 2014; 96: 539-542. https://doi.org/10.1308/003588414X14055925058238.

LinkOut - more resources