Combined laparoscopic and endoscopically assisted reversal of Hartmann's procedure (CLEAR technique)

Introduction: Although evidence is growing that most patients who need an operation for a left sided colonic or sigmoid disease can be treated by a single-stage procedure, a two-stage procedure will still be necessary in some patients because of significant sepsis or technical difficulties.  Restoration of colorectal continuity is the second step of the procedure originally described by Hartmann in1923 for the treatment of sigmoid colon cancers. It is a complex procedure, which needs a meticulous surgical technique and is associated with a significant morbidity. In recent years, enthusiasm for laparoscopic reversal of Hartmann's procedure has increased, with the outcomes of many series suggesting that it has a reduced morbidity and mortality compared with the open procedure.
Aim of the work: The aim of this paper is to describe a new minimally invasive combined laparoscopic and endoscopically assisted approach to restore bowel continuity after Hartmann's procedure. CLEAR= Combined Laparoscopic and Endoscopically Assisted Reversal.
Conclusion: In this novel technique, the combination of the laparoscopic and endoscopic views as well as trans-illumination, gives the surgeon additional feedback as regards the proper plane of dissection especially in attempting Hartmann's reversal of a difficult rectal stump.