Conventional and laparoscopic reversal of the hartmann procedure: A review of literature

Abstract

Purpose: The aim of this study was to provide a systematic overview on both laparoscopic and conventional Hartmann reversal. Furthermore, the Hartmann procedure is reevaluated in the light of new emerging alternatives. Methods: Medline, Ovid, EMBASE, and Cochrane database were searched for studies reporting on outcomes after Hartmann reversal. Results: Thirty-five studies were included in this review of which 30 were retrospective. A total of 6,249 patients with a mean age of 60 years underwent Hartmann reversal. Two thirds of patients were classified as American Society of Anesthesiologists (ASA) I-II. The mean reversal rate after a Hartmann procedure was 44%, and mean time interval between Hartmann procedure and Hartmann reversal was 7. 5 months. The most frequent reported reasons for renouncing Hartmann reversal were high ASA classification and patients' refusal. The overall morbidity rate ranged from 3% to 50% (mean 16. 3%) and mortality rate from 0% to 7. 1% (mean 1%). Patients treated laparoscopically had a shorter hospital stay (6. 9 vs. 10. 7 days) and appeared to have lower mean morbidity rates compared to conventional surgery (12. 2% vs. 20. 3%). Conclusion: Hartmann reversal carries a high risk on perioperative morbidity and mortality. The mean reversal rate is considerably low (44%). Laparoscopic reversal compares favorably to conventional; however, high level evidence is needed to determine whether it is superior. © 2009 The Author(s).