Department of Surgery, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, Stockton-on-Tees, UK.
Welwitschia Hospital, Walvis Bay, Namibia.
Colorectal Dis. 2019 Jul;21(7):833-840. doi: 10.1111/codi.14617. Epub 2019 Apr 9.
Restoration of bowel continuity after Hartmann's procedure (RoH) can be challenging and associated with considerable morbidity. A technique using single-incision laparoscopic surgery through the stoma site (SIL RoH) has been shown to be feasible and safe. In this study, we compared clinical outcomes of SIL RoH with conventional laparoscopic surgery (CL) and open surgery (OS).
This was a retrospective analysis of a prospectively maintained database between 2007 and 2017 in a UK colorectal unit. The access technique was decided by the surgeon on a case by case basis.
A total of 106 patients underwent RoH. It was carried out for diverticular disease (n = 71, 67.6%), cancer (n = 19, 17.9%) and anastomotic leak (n = 4, 3.8%). The remainder (n = 12, 11.3%) were for miscellaneous reasons including trauma. Most RoHs were performed via OS (n = 87, 81.1%). The most common intended approaches for RoH were SIL (n = 56, 52.8%) and OS (n = 34, 32.1%) with fewer starting with CL (n = 16, 15.1%). Conversion to OS took place in five (8.9%) patients with SIL and six (37.5%) with CL (P = 0.005). Postoperative complications occurred in 17 (30.4%) for SIL, seven (43.8%) for CL and 17 (50.0%) for OS (P = 0.162). Median operating time for SIL was 146 min (range 44-389), 211 min (109-320) for CL and 211 min (85-420) for OS (P < 0.001). Median length of stay was 4 days (2-44) for SIL compared to 6 (3-34) for CL and 7 (4-34) for OS (P < 0.001). Discharge on or before day 5 was achieved in 41 (74.5%) patients for SIL compared to six (37.5%) for CL and seven (20.6%) for OS (P < 0.001).
Compared to OS and CL, SIL RoH appears to have shorter operating times and hospitalization, with no discernible difference in morbidity; this finding requires further evaluation in a randomized setting.
Hartmann 手术后恢复肠连续性（RoH）具有挑战性，且与相当大的发病率有关。通过造口部位进行单切口腹腔镜手术（SIL RoH）的技术已被证明是可行且安全的。在这项研究中，我们比较了 SIL RoH 与传统腹腔镜手术（CL）和开放式手术（OS）的临床结果。
这是 2007 年至 2017 年期间在英国结直肠单位进行的前瞻性维护数据库的回顾性分析。手术入路由外科医生根据具体情况决定。
共有 106 例患者接受了 RoH。其原因包括憩室疾病（n=71，67.6%）、癌症（n=19，17.9%）和吻合口漏（n=4，3.8%）。其余（n=12，11.3%）为包括创伤在内的其他各种原因。大多数 RoH 通过 OS 进行（n=87，81.1%）。RoH 最常见的预期方法是 SIL（n=56，52.8%）和 OS（n=34，32.1%），较少采用 CL（n=16，15.1%）。有 5 例（8.9%）SIL 和 6 例（37.5%）CL 转为 OS（P=0.005）。SIL 术后并发症 17 例（30.4%），CL 术后并发症 7 例（43.8%），OS 术后并发症 17 例（50.0%）（P=0.162）。SIL 的中位手术时间为 146 分钟（44-389 分钟），CL 为 211 分钟（109-320 分钟），OS 为 211 分钟（85-420 分钟）（P<0.001）。SIL 的中位住院时间为 4 天（2-44 天），CL 为 6 天（3-34 天），OS 为 7 天（4-34 天）（P<0.001）。SIL 有 41 例（74.5%）在第 5 天或之前出院，CL 有 6 例（37.5%），OS 有 7 例（20.6%）（P<0.001）。
与 OS 和 CL 相比，SIL RoH 似乎具有较短的手术时间和住院时间，且发病率无明显差异；这一发现需要在随机环境中进一步评估。
