title: Reversal of the Hartmann's procedure: A comparative study of laparoscopic versus open surgery.
abstract: BACKGROUND
  The Hartmann's operation, although less frequently performed today, is still used when initial colonic anastomosis is too risky in the short term. However, the subsequent procedure to restore gastrointestinal continuity is associated with significant morbidity and mortality.
  
  
  METHODS
  The review of an institutional review board (IRB)-approved prospectively maintained database provided data on the Hartmann's reversal procedure performed by either laparoscopic or open technique at our institution. The data collected included: demographic data, operative approach, conversion for laparoscopic cases and perioperative morbidity and mortality.
  
  
  RESULTS
  Over a 14-year period from January 1997 to August 2011, 74 Hartmann's reversal procedures were performed (laparoscopic surgery-49, open surgery-25). The average age was 55 years for the laparoscopic and 57 years for the open surgery group, respectively. Male patients represent 61% of both groups. There was no significant difference in operative time between the two groups (149 min vs 151 min; P = 0.95), and there was a tendency to lower morbidity (3/49-7.3% vs 4/25-16%; P = 0.24) in the laparoscopic surgery group. In the laparoscopic group, eight patients (16.3%) were converted to open surgery, mostly due to severe adhesions. The length of hospital stay was significantly shorter for the laparoscopic group (5 days vs 7 days; P = 0.44).
  
  
  CONCLUSIONS
  The Hartmann's reversal procedure can be safely performed in the majority of the cases using a laparoscopic approach with a low morbidity rate and achieving a shorter hospital stay.
authors.affiliation: Colorectal Surgery Unit, Hospital del Salvador; Department of Colon and Rectal Surgery, Clinica Alemana, Santiago, Chile.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Melkonian
authors.affiliation: Colorectal Surgery Unit, Hospital del Salvador, Santiago, Chile.
authors.forename: Claudio
authors.initials: C
authors.lastname: Heine
authors.affiliation: Colorectal Surgery Unit, Hospital del Salvador, Santiago, Chile.
authors.forename: David
authors.initials: D
authors.lastname: Contreras
authors.affiliation: Colorectal Surgery Unit, Hospital del Salvador, Santiago, Chile.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Rodriguez
authors.affiliation: Colorectal Surgery Unit, Hospital del Salvador, Santiago, Chile.
authors.forename: Patricio
authors.initials: P
authors.lastname: Opazo
authors.affiliation: Colorectal Surgery Unit, Hospital del Salvador, Santiago, Chile.
authors.forename: Andres
authors.initials: A
authors.lastname: Silva
authors.affiliation: Colorectal Surgery Unit, Hospital del Salvador, Santiago, Chile.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Robles
authors.affiliation: Colorectal Surgery Unit, Hospital del Salvador, Santiago, Chile.
authors.forename: Rolando
authors.initials: R
authors.lastname: Rebolledo