title: Reversal of Hartmann's procedure utilizing single-port laparoscopy: an attractive alternative to laparotomy.
abstract: BACKGROUND
  Complications after restoration of intestinal continuity (RIC) following Hartmann's procedure occur frequently and are often serious. These complications result in a reported morbidity of 4-30 % and a reported mortality of 10-14 %. Reducing the amount of surgical trauma accompanying abdominal access seems an attractive tool to reduce perioperative morbidity. This possibility is offered by single-port Hartmann's reversal (SPHR) through the colostomy site.
  
  
  METHODS
  The purpose of the present prospective study was to compare outcome of SPHR to a retrospectively collected historical control group of conventional open Hartmann's reversal (OHR). All patients undergoing RIC between January 1, 2009, and January 1, 2014, were included in the present study. Operation time, morbidity and hospital stay were assessed. Postoperative surgical results of SPHR and OHR were the main outcome of the study.
  
  
  RESULTS
  During the study period, 41 patients (M/F = 23:18; median age 58 (26-85) years) were included in the present study. Sixteen patients underwent OHR; 25 patients underwent SPHR. No mortality was observed in the present series. Median operation time was similar between groups [184 (29-377) vs. 153.5 (73-332) min]. Hospital stay was significantly shorter in the SPHR group [16 (4-74) vs. 4 (1-34) days, p < 0.05]. The number of complications was significantly lower in the SPHR group (33 vs. 10, p < 0.05); furthermore, significantly less patients had severe complications (Clavien-Dindo III or higher) in the SPHR group (7/33 vs. 1/10). Less wound-related complications occurred in the SPHR group (12 vs. 5, p < 0.05).
  
  
  CONCLUSIONS
  This study confirms recent findings in the literature regarding the safety and feasibility of SPHR. SPHR seems to be an attractive alternative to OHR.
authors.affiliation: Department of Surgery, Elisabeth-TweeSteden Hospital, 5042 AD, Tilburg, The Netherlands. s.clermonts@tsz.nl.
authors.forename: Stefan H E M
authors.initials: SH
authors.lastname: Clermonts
authors.affiliation: Department of Surgery, Elisabeth-TweeSteden Hospital, 5042 AD, Tilburg, The Netherlands.
authors.forename: Winanda M J
authors.initials: WM
authors.lastname: de Ruijter
authors.affiliation: Department of Surgery, Elisabeth-TweeSteden Hospital, 5042 AD, Tilburg, The Netherlands.
authors.forename: Yu-Ting T
authors.initials: YT
authors.lastname: van Loon
authors.affiliation: Department of Surgery, Elisabeth-TweeSteden Hospital, 5042 AD, Tilburg, The Netherlands.
authors.forename: Dareczka K
authors.initials: DK
authors.lastname: Wasowicz
authors.affiliation: Department of Surgery, Elisabeth-TweeSteden Hospital, 5042 AD, Tilburg, The Netherlands.
authors.forename: Joos
authors.initials: J
authors.lastname: Heisterkamp
authors.affiliation: Department of Surgery, Elisabeth-TweeSteden Hospital, 5042 AD, Tilburg, The Netherlands.
authors.forename: John K
authors.initials: JK
authors.lastname: Maring
authors.affiliation: Department of Surgery, Elisabeth-TweeSteden Hospital, 5042 AD, Tilburg, The Netherlands.
authors.forename: David D E
authors.initials: DD
authors.lastname: Zimmerman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D016022:Case-Control Studies; D003110:Colonic Neoplasms / Q000601:surgery; D003125:Colostomy / Q000379:methods*; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000601:surgery*; D007431:Intraoperative Complications / Q000209:etiology; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011184:Postoperative Period; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies
keywords: Hartmann’s procedure; Laparotomy; Restoration of continuity; Reversal; Single port; Stoma site