Conventional and laparoscopic reversal of the Hartmann procedure: a review of literature.
OBJECTIVE
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%).


CONCLUSIONS
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.
van de Wall
Bryan Joost Marinus
BJ
Department of Surgery, Meander Medical Center, Utrechtseweg 160, 3818 ES Amersfoort, The Netherlands.
Draaisma
Werner A
WA
Schouten
Esther S
ES
Broeders
Ivo A M J
IA
Consten
Esther C J
EC
D015179:Colorectal Neoplasms / Q000601:surgery*; D003107:Colorectal Surgery / Q000379:methods*; D003125:Colostomy; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy; D011183:Postoperative Complications; D012086:Reoperation