Laparoscopic Reversal of Hartmann's Procedure: State of the Art 20 Years after the First Reported Case

Aim of the present work is a to review the literature after the first laparoscopic reversal of Hartmann procedure and to point out the role of this technique according with actual possibilities of treatment.MATERIAL AND METHODSOutcome variables included number of patients, mean age, sex, etiology of Hartmann’s procedureHinchey classification for the first surgical procedure, interval between initial procedure andreversal, position of the first trocars, mean operative time (min), number of patients converted to open surgery, causes of convertion, lenght of stay, mortality, complications and quality of life were considered for the study.RESULTSA total of 684 patients were analyzed. The range was between 38 and 67 years (mean 49.3 years). The patients were 238 male (52.4%) and 216 female (47.6%). The etiology of Hartmann’s procedure was in 292 patients (72.1%) for perforated sigmoid diverticulitis, in 43 patients (10.6%) for sigmoid carcinoma and in 70 patients (17.3%) for others causes. The Hinchey classification was reported only in 7 articles (22.6%). The range of the interval between initial procedure and reversal was between 50 and 330 days (mean 163.1 days). The initial trocar was positioned in 182 patients(43.2%) with an open port placement through an umbilical incision, in 177 patients (41.9%) in right upper quadrant and in 63 patients (14.9%) colostomy site. The range of the mean operative time was between 69 and 285 minutes (mean 156.6 min). A total of the 83 patients 12.1%) wereconverted in open technique. The causes of the convertions were reported in 56 patients (67.4%). The range of the lenght of stay was between 3 and 12 days (mean 6,1 days). The mortality was of 5 patients (0,7%). The complications concern 112 cases (16.4%).CONCLUSIONThe laparoscopic Hartmann's reversal is safer and achieves faster positive results in relation to the open Hartman reversal.