Goncharov A L, Chicherina M A, Aslanyan A S, Muratov I I, Gallyamov E A
Central Clinical Hospital of the Presidential Administration of the Russian Federation, Moscow, Russia.
Sechenov First Moscow State Medical University, Moscow, Russia.
Khirurgiia (Mosk). 2023(8):54-61. doi: 10.17116/hirurgia202308154.
To analyze intraoperative and early postoperative results of open and laparoscopic reversal of Hartmann's (HR) procedure in patients with diverticular disease.
A single-center retrospective non-randomized study included 31 patients with complicated form of diverticular disease between 2018 and 2022. Patients underwent reversal of Hartmann's procedure (laparoscopic surgery - 19, laparotomy - 12).
Mean time of laparoscopy and open surgery was 202±36.7 and 223±41 min, respectively. There were no intraoperative complications in both groups and conversions of laparoscopic reversal of Hartmann's procedure. No preventive stoma was required. Mean postoperative hospital-stay was 7.6±3.2 and 9.5±4.6 days, respectively. Overall incidence of postoperative complications was 32.2% (=10), i.e. 4 (21%) and 6 (50%) patients in both groups, respectively. Anastomotic leakage occurred in one patient after open surgery.
In our sample, incidence of complications was low after reversal of Hartmann's procedure in patients with complicated diverticular disease. There was 1 (3.2%) patient with anastomotic leakage, and no temporary stoma was formed. In patients who underwent laparoscopic Hartmann's procedure at the first stage and selected patients after open surgeries, laparoscopic reversal procedures were accompanied by no conversions. There were favorable results typical for minimally invasive surgery. Selection criteria for laparoscopic access are discussable. Large-scale studies including randomized trials are needed to verify selection criteria for minimally invasive reversal of Hartmann's procedure and demonstrate its advantages over open surgery.
分析憩室病患者行Hartmann手术开放和腹腔镜复位的术中及术后早期结果。
一项单中心回顾性非随机研究纳入了2018年至2022年间31例复杂形式憩室病患者。患者接受了Hartmann手术复位（腹腔镜手术 - 19例，开腹手术 - 12例）。
腹腔镜手术和开放手术的平均时间分别为202±36.7分钟和223±41分钟。两组均无术中并发症，且Hartmann手术腹腔镜复位无中转开腹情况。无需预防性造口。术后平均住院时间分别为7.6±3.2天和9.5±4.6天。术后并发症总发生率为32.2%（=10例），即两组分别有4例（21%）和6例（50%）患者。开腹手术后有1例患者发生吻合口漏。
在我们的样本中，复杂憩室病患者Hartmann手术复位后并发症发生率较低。有1例（3.2%）患者发生吻合口漏，且未形成临时造口。在第一阶段接受腹腔镜Hartmann手术的患者以及部分开腹手术后选择的患者中，腹腔镜复位手术无中转开腹情况。呈现出微创手术典型的良好结果。腹腔镜入路的选择标准值得探讨。需要开展包括随机试验在内的大规模研究，以验证Hartmann手术微创复位的选择标准，并证明其优于开放手术。
