Golash Vishwanath
Department of Surgery, Sultan Qaboos Hospital, Salalah, Sultanate of Oman.
J Minim Access Surg. 2006 Dec;2(4):211-5. doi: 10.4103/0972-9941.28182.
The Hartmann procedure is a standard life-saving operation for acute left colonic complications. It is usually performed as a temporary procedure with the intent to reverse it later on. This reversal is associated with considerable morbidity and mortality by open method. The laparoscopic reestablishment of intestinal continuity after Hartmann procedure has shown better results in terms of decrease in morbidity and mortality.
The laparoscopic technique was used consecutively in 12 patients for the reversal of Hartmann procedure in the last 3 years. The adhesiolysis and mobilization of the colon was done under laparoscopic guidance. The colostomy was mobilized and returned to abdominal cavity after tying the anvil in the proximal end. An end-to-end intracorporeal anastomosis was performed between the proximal colon and the rectum using the circular stapler.
Mean age of the patients was 40 years and the mean time of restoration of intestinal continuity was 130 days. Two patients were converted to open. The mean time of operation was 90 min. There were no postoperative complications and mortality. The mean hospital stay was 5 days.
Laparoscopic reversal of Hartmann is technically safe and feasible.
哈特曼手术是治疗急性左半结肠并发症的标准挽救生命的手术。它通常作为一种临时手术进行，目的是日后进行逆转。通过开放手术进行这种逆转与相当高的发病率和死亡率相关。哈特曼手术后腹腔镜重建肠道连续性在降低发病率和死亡率方面显示出更好的效果。
在过去3年中，连续对12例患者采用腹腔镜技术进行哈特曼手术逆转。在腹腔镜引导下进行结肠粘连松解和游离。在近端系上吻合器砧座后，将结肠造口游离并回纳至腹腔。使用圆形吻合器在近端结肠和直肠之间进行端端体内吻合。
患者平均年龄为40岁，肠道连续性恢复的平均时间为130天。2例患者转为开放手术。平均手术时间为90分钟。无术后并发症和死亡。平均住院时间为5天。
腹腔镜下哈特曼手术逆转在技术上是安全可行的。
