Laparoscopic versus open reversal of Hartmann's procedure: A retrospective review

Abstract

Background: Restoration of bowel continuity following Hartmann's procedure may be performed using a laparoscopic or open technique. This study is the first of its kind comparing laparoscopic with open reversal of Hartmann's procedure in Australasia. Methods: This is a retrospective review of 107 patients who underwent either a laparoscopic (n = 43) or open (n = 64) reversal of Hartmann's procedure between 2001 and 2012. Outcome measures were perioperative clinical outcomes and post-operative complications. Results: Patients in the two groups were comparable in age, body mass index, American Society of Anesthesiologists score and number of previous operations. The most common indication for the original Hartmann's operation in both groups was diverticular disease. Total theatre time was longer for the laparoscopic group (276.4 versus 242.0min; P = 0.02). Three patients in the laparoscopic group required conversion to laparotomy (7%). Laparoscopic reversal of Hartmann's procedure was associated with shorter time to passage of flatus (2.8 versus 4.0 days; P < 0.001) and faeces (4.2 versus 5.6 days; P = 0.002), and shorter overall length of hospital stay (6.7 versus 10.8 days; P < 0.001). There were fewer patients in the laparoscopic group who had post-operative complications (14% versus 31%; P = 0.04), including fewer cases of post-operative ileus (2% versus 17%; P = 0.02). There were no cases of anastomotic leak or in-hospital mortality in either group. Conclusion: Laparoscopic reversal of Hartmann's procedure is a safe and feasible alternative to open Hartmann's reversal and may be associated with significantly faster recovery time and fewer post-operative complications.