Outcomes of Laparoscopic Reversal of Hartmann’s Procedure after Open Sigmoidectomy: Our Early Experience

Background: Reversal of Hartmann’s procedure is a demanding, difficult colorectal operation that may be associated
with several postoperative complications. This can be achieved either in an open approach or laparoscopically.
Laparoscopic procedure were documented to have more advantages than open one. This study was designed
to assess the perioperative outcomes and safety of laparoscopic reversal of Hartmann’s procedure after open
sigmoidectomy among Egyptian patients.
Patients and Methods: Eligible patients operated for reversal of their Hartmann’s procedure after open
sigmoidectomy between 2018 and 2021 were included. Preoperative and intraoperative data were collected.
Postoperative outcomes included bowel function, possible complications and length of hospital stay.
Results: Reversal of Hartmann’s procedure was performed in 48 patients (17 laparoscopic and 31 open). The age
of the patients was significantly lower in laparoscopic group compared to open group. All patients were comparable
regarding their gender, body mass index (BMI) and the number of previous abdominal operations in the two
groups. Time since Hartmann’s procedure was significantly shorter among laparoscopic group (132 ± 26 vs 198 ±
54 days). Laparoscopic group had significantly longer operative time (245 ±35.3 vs 201.3 ± 31 mins), significantly
shorter hospital stays and reduction in the time to restore their bowel function compared to open group. Only 5
of the laparoscopic group required conversion to laparotomy. There were fewer patients in the laparoscopic group < br />who had postoperative complications (17.6% versus 51.6%).
Conclusion: Laparoscopic reversal of Hartmann’s procedure after open sigmoidectomy was found to be safe in
this study and is associated with a faster recovery time, shorter length of hospital stays and less postoperative
complications. However, the findings would need to be confirmed by a large prospective cohort study.