Kang Byung Mo, Kim Chang Woo, Lee Suk-Hwan
Department of Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.
Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.
Ann Coloproctol. 2021 Feb;37(1):29-34. doi: 10.3393/ac.2020.09.21. Epub 2020 Dec 4.
Recently, laparoscopic reversal of Hartmann's colostomy was performed with favorable outcomes by many surgeons. We partially applied the concepts of single-port laparoscopic procedure through the colostomy site to remove intraperitoneal adhesion during initial step of the laparoscopic Hartmann's reversal. This study aimed to evaluate the feasibility and safety of the laparoscopic reversal of Hartmann's colostomy with the application of single-port laparoscopic techniques through the colostomy site.
From October 2008 to November 2018, the laparoscopic Hartmann's reversal was attempted in 20 patients. After colostomy take-downs, the single-port device was installed at the colostomy site and the single-port laparoscopic procedure was performed to remove intraperitoneal adhesions to provide space for additional trocars. After additional trocars were inserted, the descending colon and rectal stump were mobilized, and the colorectal anastomosis was completed. We retrospectively reviewed the medical records and analyzed the data to identify the perioperative complication rates as the primary outcome.
Of the 20 patients, 3 patients (15.0%) had open conversions due to severe adhesions. Intraoperative small bowel injuries occurred in 2 patients (10.0%) and these were repaired through the colostomy site. Postoperative complications developed in 4 patients (20.0%) and were managed with medical treatments or wound closures under local anesthesia.
The single-port laparoscopic procedure through the colostomy site is sufficiently safe in order to complete the Hartmann's reversal. We recommend that the colostomy site should be used as the access route into the abdominal cavity for the Hartmann's reversal.
近来，许多外科医生开展了腹腔镜下哈特曼结肠造口术的回纳手术，效果良好。我们在腹腔镜下哈特曼回纳术的初始步骤中，通过结肠造口部位部分应用了单孔腹腔镜手术的理念，以清除腹腔内粘连。本研究旨在评估经结肠造口部位应用单孔腹腔镜技术进行腹腔镜下哈特曼结肠造口术回纳的可行性和安全性。
2008年10月至2018年11月，对20例患者尝试进行腹腔镜下哈特曼回纳术。在拆除结肠造口后，将单孔装置安装在结肠造口部位，并进行单孔腹腔镜手术以清除腹腔内粘连，为额外的套管针提供空间。插入额外的套管针后，游离降结肠和直肠残端，完成结直肠吻合。我们回顾性分析病历并分析数据，将围手术期并发症发生率作为主要观察指标。
20例患者中，3例（15.0%）因粘连严重转为开腹手术。2例患者（10.0%）术中发生小肠损伤，通过结肠造口部位进行了修复。4例患者（20.0%）出现术后并发症，经药物治疗或局部麻醉下伤口缝合处理。
经结肠造口部位的单孔腹腔镜手术在完成哈特曼回纳术时足够安全。我们建议将结肠造口部位作为哈特曼回纳术进入腹腔的入路。
