Comparison between open and laparoscopic reversal of Hartmann’s procedure for diverticulitis

AIM: To compare the open and laparoscopic Hartmann’s reversal in patients first treated for complicated diverticulitis.METHODS: Forty-six consecutive patients with diverticular disease were included in this retrospective,singlecenter study of a prospectively maintained colorectal surgery database.All patients underwent conventional Hartmann’s procedures for acute complicated diverticulitis.Other indications for Hartmann’s procedures were excluded.Patients underwent open(OHR) or laparoscopic Hartmann’s reversal(LHR) between 2000 and 2010,and received the same pre-and post-operative protocols of cares.Operative variables,length of stay,short-(at 1 mo) and long-term(at 1 and 3 years) postoperative complications,and surgery-related costs were compared between groups.RESULTS: The OHR group consisted of 18 patients(13 males,mean age ± SD,61.4 ± 12.8 years),and the LHR group comprised 28 patients(16 males,mean age 54.9 ± 14.4 years).The mean operative time and the estimated blood loss were higher in the OHR group(235.8 ± 43.6 min vs 171.1 ± 27.4 min;and 301.1 ± 54.6 mL vs 225 ± 38.6 mL respectively,P = 0.001).Bowel function returned in an average of 4.3 ± 1.7 d in the OHR group,and 3 ± 1.3 d in the LHR group(P = 0.01).The length of hospital stay was significantly longer in the OHR group(11.2 ± 5.3 d vs 6.7 ± 1.9 d,P 【 0.001).The 1 mo complication rate was 33.3% in the OHR(6 wound infections) and 3.6% in the LHR group(1 hemorrhage)(P = 0.004).At 12 mo,the complication rate remained significantly higher in the OHR group(27.8% vs 10.7%,P = 0.03).The anastomotic leak and mortality rates were nil.At 3 years,no patient required re-intervention for surgical complications.The OHR procedure had significantly higher costs(+56%) compared to the LHR procedure,when combining the surgery-related costs and the length of hospital stay.CONCLUSION: LHR appears to be a safe and feasible procedure that is associated with reduced hospitality stays,complication rates,and costs compared to OHR.

Laparoscopic reversal of Hartmann’s procedure:safety and feasibility

Aims:The present study aimed to compare the surgical outcomes of patients receiving laparoscopic reversal of Hartmann’s procedure(RHP)with those receiving open surgery.Methods:Records of all patients with RHP performed in our unit(including laparoscopic and open surgery)between 2000 and 2012 were retrieved.Data were retrospectively reviewed and compared.Results:Eighty-two RHPs were performed between 2000 and 2012.Thirty-five were performed with an open approach and 47 with a laparoscopic approach.Conversion rate was 28%in the laparoscopic group.There was no difference,between the two groups,in operation time or blood loss.The median length of stay was significantly shorter in the laparoscopic group(12 vs 14 days,P=0.002)and fewer patients in the laparoscopic group had complications with post-operative paralytic ileus(2 vs 17%,P=0.038).None of the patients in the laparoscopic group developed incisional hernia at the conclusion of follow-up,as opposed to five in the open group(0 vs 14%,P=0.012).Conclusion:Laparoscopic RHP is safe and feasible,with more favorable surgical outcomes,when compared with open surgery.Conversion rate is acceptable.It should be the technique of choice for patients undergoing RHP.