title: Efficacy of laparoscopic-assisted approach for reversal of Hartmann's procedure: results from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.
abstract: BACKGROUND
  Morbidity after reversal of Hartmann's procedure remains high. The laparoscopic approach (LAP) may be associated with lower morbidity versus open Hartmann's closure. This study's aim is to compare results after LAP and OPEN colostomy takedown and Hartmann's reversal.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2005 to 2012 for CPT procedure codes 44227 (LAP) and 44626 (OPEN). Exclusion criteria included: ventilator dependence, ASA class 4 or 5, SIRS, sepsis, emergency case, and advanced malignancy. Demographic parameters were assessed as well as comorbidities and short-term outcomes. Statistical methods used include Fisher's exact test for categorical variables and Student's t test for continuous variables.
  
  
  RESULTS
  In total, 4,148 patients underwent stoma closure and Hartmann's reversal (LAP 732 [17.6 %], OPEN 3,416 [82.3 %]). The mean BMI was lower in the LAP (mean ± SD 27.6 ± 6.6) versus OPEN group (28.3 ± 6.8, p = 0.012). The groups were similar as regards comorbidities except for dyspnea (LAP 5.6 %, OPEN 7.8 %, p = 0.043). The mean surgery times were similar and the median LOS shorter in the LAP versus OPEN groups (5 vs 6 days, p < 0.0001). A lower overall morbidity rate was noted for the LAP group (18.4 % vs OPEN 27 %, p < 0.0001) but mortality was statistically similar. Lower rates were noted in the LAP group for the following complications: incisional SSI (10.4 vs 14.1 %, p = 0.033), organ space SSI (3.1 vs 5.0 %, p = 0.033), UTI (1.6 vs 3.3 %, p = 0.005), sepsis (3.4 vs 6.0 %, p = 0.038), and reoperation (3.1 vs 5.4 %, p = 0.011).
  
  
  CONCLUSIONS
  Only 18 % of Hartmann's reversal's were done using LAP methods. The LAP and OPEN groups were similar except for gender, BMI, and dyspnea history. LAP methods were associated with a 1 day LOS benefit and significantly lower overall morbidity and lower rates of incisional and deep SSI, UTI, sepsis, and reoperations. Operative length was similar. The short-term results of the LAP approach are superior to the OPEN results.
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Mount Sinai Roosevelt Hospital, Suite 7B, 425 West, 59th Street, New York, NY, 10019, USA.
authors.forename: Jeanine
authors.initials: J
authors.lastname: Arkenbosch
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Miyagaki
authors.forename: H M C Shantha
authors.initials: HM
authors.lastname: Kumara
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Yan
authors.forename: Vesna
authors.initials: V
authors.lastname: Cekic
authors.forename: Richard L
authors.initials: RL
authors.lastname: Whelan
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D003082:Colectomy / Q000379:methods*; D016208:Databases, Factual; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D061646:Operative Time; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D058996:Quality Improvement; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D014481:United States