Department Barcelona, Gastrointestinal Surgery, Hospital Clínic de Barcelona, Carrer de Villaroel 170, 08036, Barcelona, Catalonia, Spain.
Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Assomption, Montreal, Quebec, H1T 2M4, Canada.
Surg Endosc. 2017 Dec;31(12):4981-4987. doi: 10.1007/s00464-017-5462-8. Epub 2017 Jun 13.
Restoration of intestinal continuity after Hartmann's procedure is a technically difficult surgery associated with significant morbidity and mortality. This study presents the short-term results of a new approach: a transanal Hartmann's colostomy reversal assisted by laparoscopy.
This is a retrospective analysis of data collected in one tertiary hospital, from October 2013 to November 2015.
During the study period, there were ten cases of transanal Hartmann's reversal. Reasons for Hartmann's procedure were: complicated diverticulitis (4), anastomotic leak (3), and recto-sigmoid cancer (3). Rectal stump length was 10.4 ± 4.5 cm. Reconstruction was achieved in all patients. One low colorectal anastomosis was hand-sewn, the other 9 were stapled. Mean operative time was 204 ± 65 min. Diverting loop ileostomies were created in five patients and all were closed during the following year. One case required hand-assistance but there was no conversion to open surgery. Iatrogenic laparoscopic enterotomies occurred in four patients and all were repaired primarily without consequences. Three patients had a total of four post-operative complications: ileus (2), abdominal abscess and wound infection (1). None required reoperation. Mean length of stay was 7.2 ± 4.3 days. One required readmission.
A transanal Hartmann's reversal assisted by laparoscopy is a new approach for a difficult surgery. It has the potential to be an additional tool in the case of hostile pelvises or with a rectal stump difficult to identify. The surgery remains challenging and indications need to be clarified.
Hartmann 手术后恢复肠道连续性是一项技术难度较大的手术，与较高的发病率和死亡率相关。本研究介绍了一种新方法的短期结果：经肛门 Hartmann 结肠造口还纳术辅助腹腔镜手术。
这是对一家三级医院在 2013 年 10 月至 2015 年 11 月期间收集的数据进行的回顾性分析。
在研究期间，有 10 例经肛门 Hartmann 还纳术。行 Hartmann 手术的原因包括：复杂憩室炎（4 例）、吻合口漏（3 例）和直肠乙状结肠癌（3 例）。直肠残端长度为 10.4±4.5cm。所有患者均完成重建。1 例低位直肠乙状结肠吻合口手工缝合，其余 9 例使用吻合器吻合。手术平均时间为 204±65min。5 例患者行预防性回肠末端造口术，均在术后 1 年内关闭。1 例需要手辅助，但无中转开腹。4 例患者发生医源性腹腔镜肠穿孔，均一期修补，无并发症。3 例患者共发生 4 例术后并发症：肠梗阻（2 例）、腹部脓肿和伤口感染（1 例）。无患者需要再次手术。平均住院时间为 7.2±4.3 天。1 例患者需要再次住院。
经肛门 Hartmann 还纳术辅助腹腔镜手术是一项困难手术的新方法。对于骨盆情况不佳或直肠残端难以识别的患者，它可能成为一种额外的治疗手段。但该手术仍然具有挑战性，适应证需要进一步明确。
