[Laparoscopically guided reversal of Hartmann's procedure].

UNLABELLED

Morbidity and mortality after reversal of Hartmann's procedure following perforated sigmoid diverticulitis are high and the rate of intestinal restoration is low.

AIM

To investigate whether laparoscopically assisted reversal of Hartmann's procedure is technically feasible and whether the laparoscopic procedure offers any benefit to the patient.

METHOD

Nineteen patients were investigated. The postoperative course was followed prospectively. All patients were reinvestigated 9 months after surgery.

RESULTS

Laparoscopic reversal of Hartmann's procedure was attempted in 19 patients. One patient did not want the laparoscopic technique. In two cases (11 %) conversion to the conventional technique was necessary; thus, 16 patients were operated laparoscopically. Median operative time was 114 (65-180) min. With the exception of three wound infections no immediate postoperative complications were noticed. Patients' convalescence was fast. First evacuation took place 3.3 (3-5) days after surgery, complete oral nutrition 3.6 (3-5) days after surgery. Duration of postoperative hospitalisation was 7.5 (5-12) days. One patient developed later a clinically significant anastomotic stricture which needed endoscopic dilatation.

CONCLUSION

Laparoscopically assisted Hartmann's reversal is technically demanding but feasible. Postoperative morbidity is low, duration of hospitalisation short, convalescence fast. Thus, good arguments exist for performing reversal of Hartmann's procedures laparoscopically.