Laparoscopic Hartmann's procedure: a viable option for treatment of acutely perforated diverticultis.
BACKGROUND
A laparoscopic technique for acutely perforated diverticulitis (i.e., laparoscopic Hartmann's procedure) has not been described. The authors present their technique for laparoscopic sigmoid resection, end colostomy, and subsequent laparoscopic takedown of colostomy.


METHODS
A retrospective review of patients with Hinchey III/IV diverticulitis who underwent a laparoscopic Hartmann's procedure was performed in this study. Laparoscopic takedown of sigmoid colostomy was performed 2 to 3 months later. Data from these procedures including estimated blood loss (EBL), length of the operative procedure, patient outcomes, and demographics were evaluated.


RESULTS
Seven patients with a mean age of 49.7 years underwent laparoscopic sigmoid colectomy with end colostomy. None of these patients had a history of diverticulitis. Their mean EBL was 138 ml, and their mean operative time was 154 min. None of the procedures required conversion to use of a hand port or conversion to open procedure. The average time to return of bowel function was 3.7 days, with one patient experiencing a postoperative ileus. The mean postoperative hospital stay was 6.6 days. There were no complications. Laparoscopic Hartmann's takedown was performed for all the patients approximately 2 to 3 months later. The mean EBL was 107 ml, and the average operative time was 189 min. One patient had intraoperative anastomotic leak, which was successfully repaired and retested. Again, none of the procedures required the use of a hand port or a laparotomy. The average time to return of bowel function was 3.4 days. The average length of hospital stay was 5.3 days, with one patient experiencing a fat necrosis.


CONCLUSIONS
Laparoscopic Hartmann's procedure and laparoscopic takedown are technically feasible procedures with reasonable outcomes.
Agaba
Emmanuel A
EA
Department of Surgery, North Shore-LIJ Health System, North Shore University Hospital, Manhasset, NY 11030, USA. eagaba@gmail.com
Zaidi
Raza M
RM
Ramzy
Peter
P
Aftab
Muhammad
M
Rubach
Eugene
E
Gecelter
Gary
G
Ravikumar
Thanjur S
TS
DeNoto
George
G
D000208:Acute Disease; D000328:Adult; D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods; D016063:Blood Loss, Surgical; D003082:Colectomy / Q000295:instrumentation / Q000379:methods*; D003125:Colostomy / Q000295:instrumentation / Q000379:methods*; D004238:Diverticulitis / Q000150:complications / Q000601:surgery*; D005218:Fat Necrosis / Q000209:etiology / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery*; D007432:Intraoperative Period; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012810:Sigmoid Diseases / Q000150:complications / Q000601:surgery*; D013528:Surgical Staplers; D054047:Surgical Stomas