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  • Title: [Laparoscopically guided reversal of Hartmann's procedure].
    Author: Köhler L, Lempa M, Troidl H.
    Journal: Chirurg; 1999 Oct; 70(10):1139-43. PubMed ID: 10550344.
    Abstract:
    UNLABELLED: Morbidity and mortality after reversal of Hartmann's procedure following perforated sigmoid diverticulitis are high and the rate of intestinal restoration is low. AIM: To investigate whether laparoscopically assisted reversal of Hartmann's procedure is technically feasible and whether the laparoscopic procedure offers any benefit to the patient. METHOD: Nineteen patients were investigated. The postoperative course was followed prospectively. All patients were reinvestigated 9 months after surgery. RESULTS: Laparoscopic reversal of Hartmann's procedure was attempted in 19 patients. One patient did not want the laparoscopic technique. In two cases (11 %) conversion to the conventional technique was necessary; thus, 16 patients were operated laparoscopically. Median operative time was 114 (65-180) min. With the exception of three wound infections no immediate postoperative complications were noticed. Patients' convalescence was fast. First evacuation took place 3.3 (3-5) days after surgery, complete oral nutrition 3.6 (3-5) days after surgery. Duration of postoperative hospitalisation was 7.5 (5-12) days. One patient developed later a clinically significant anastomotic stricture which needed endoscopic dilatation. CONCLUSION: Laparoscopically assisted Hartmann's reversal is technically demanding but feasible. Postoperative morbidity is low, duration of hospitalisation short, convalescence fast. Thus, good arguments exist for performing reversal of Hartmann's procedures laparoscopically.
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