title: Laparoscopic reversal of Hartmann's procedure.
abstract: Reestablishing continuity after a Hartmann's procedure is considered a major surgical procedure with high morbidity/mortality. The aim of this study was to assess the short-/long-term outcome of laparoscopic restoration of bowel continuity after HP. A prospectively collected database of colorectal laparoscopic procedures (>800) performed between June 2005 and June 2013 was used to identify 20 consecutive patients who had undergone laparoscopic reversal of Hartmann's procedure (LHR). Median age was 65.4. Ten patients (50 %) had undergone surgery for perforated diverticulitis, 3 (15 %) for cancer, and 7 (35 %) for other reasons (volvulus, posttraumatic perforation, and sigmoid perforation from foreign body). Previous HP had been performed laparoscopically in only 3 patients. Median operative time was 162.5 min. All the procedures were completed laparoscopically. Intraoperative complication rate was nil. Post-operative mortality and morbidity were respectively 0 and 10 % (1 pneumonia, 1 bowel obstruction from post-anastomotic stenosis which required resection and redo of the anastomosis). Median time to first flatus was 3 days, to normal diet 5 days. Median hospital stay was 9 days without readmissions. We followed up the patients for a median of 44 months: when asked, all 20 (100 %) said they would undergo the operation (LHR) again; 3 (15 %) had been re-operated of laparoscopic mesh repair for incisional hernia. When performed by experienced surgeons, LHR is a feasible, safe, reproducible operation, which allows early return of bowel function, early discharge and fast return to work for the patient. It has a low morbidity rate.
authors.affiliation: Department of General Surgery, Azienda ULSS 15 'Alta Padovana', Via Casa di Ricovero 40, 35013, Cittadella, Padova, Italy.
authors.forename: Valentino
authors.initials: V
authors.lastname: Fiscon
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Portale
authors.forename: Antonio
authors.initials: A
authors.lastname: Mazzeo
authors.forename: Giovanni
authors.initials: G
authors.lastname: Migliorini
authors.forename: Flavio
authors.initials: F
authors.lastname: Frigo
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D012809:Colon, Sigmoid / Q000601:surgery*; D003125:Colostomy / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012007:Rectum / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000601:surgery