Laparoscopically assisted Hartman's reversal is an efficacious and efficient procedure: a case control study.
OBJECTIVE
Laparoscopy may lower the mortality and morbidity rates of Hartmann's procedure reversal. However, it remains a challenging operation mainly due to adhesions of the small bowel and to the rectal stump.


METHODS
We performed a retrospective review of 44 patients who had laparoscopic Hartmann's reversal (Group A). On a case-control basis, these patients were compared to 44 patients (Group B) who had open Hartmann's reversal.


RESULTS
Preoperative patients' characteristics (sex, gender, BMI, ASA status, prior surgery, comorbidities, colonic disease) were comparable. Conversion rate in Group A was 9.1%. Operative incidents were comparable in both groups. Operative duration was not significantly shorter in Group B (195 min versus 160 min in Group B). Mortality rate was 2.2 % and O % in group A and B, respectively. Overall morbidity rate was 11.4 % and 28.6 % in Group A and B, respectively (P<0.05). The mean length of hospital stay was significantly shorter in Group A (4.8 days) as compared to Group B (6.8 days), respectively. An efficiency analysis was performed and demonstrated that laparoscopic reversal did not generate a significant additional cost.


CONCLUSIONS
Our laparoscopic technique of Hartmann's procedure reversal is safe and efficient. It compares positively with the same procedure performed openly in a case control study. Moreover, an indirect cost reduction is generated by the reduction of the length of hospital stay.
Chouillard
E
E
Department of General and Digestive Surgery Centre Hospitalier, Poissy, France. chouillard@yahoo.com
Pierard
T
T
Campbell
R
R
Tabary
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003108:Colonic Diseases / Q000401:mortality / Q000601:surgery*; D003125:Colostomy / Q000379:methods*; D013505:Digestive System Surgical Procedures / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome