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01-12-2018

Comparison between laparoscopic and open Hartmann’s reversal: results of a decade-long multicenter retrospective study

Authors: Nir Horesh, Yonatan Lessing, Yaron Rudnicki, Ilan Kent, Haguy Kammar, Almog Ben-Yaacov, Yael Dreznik, Shmuel Avital, Eli Mavor, Nir Wasserberg, Hanoch Kashtan, Joseph Klausner, Mordechai Gutman, Oded Zmora, Hagit Tulchinsky

Published in: Surgical Endoscopy | Issue 12/2018

Abstract

Background

Hartmann’s reversal is a challenging surgical procedure with significant postoperative morbidity rates. Various surgical methods have been suggested to lower the risk of postoperative complications. In this study, we aimed to compare the postoperative results between open and laparoscopic techniques for Hartmann’s reversal.

Methods

A retrospective study of all patients who underwent Hartmann’s reversal in five centers in central Israel between January 2004 and June 2015 was conducted. Medical charts were reviewed, analyzing preoperative and operative parameters and short-term postoperative outcomes.

Results

260 patients were included in the study. 76 patients were operated laparoscopically with a conversion rate of 26.3% (20 patients). No differences were found between patients operated laparoscopically and those operated in an open technique regarding gender (p = 0.785), age (61.34 vs. 62.64, p = 0.521), body mass index (26.6 vs. 26.2, p = 0.948), Charlson index score (1.79 vs. 1.95, p = 0.667), and cause for Hartmann’s procedure (neoplastic vs. non-neoplastic, p = 0.644). No differences were seen in average time from the Hartmann’s procedure to reversal (204.89 vs. 213.60 days, p = 0.688) and in overall complication rate (46.4 vs. 46.5%, p = 1). The Clavien–Dindo score for distinguishing between minor (0–2 score, p = 1) and major complications (3–5 score, p = 0.675) failed to demonstrate an advantage to laparoscopy, as well as to average length of stay (10.91 days in the laparoscopic group vs. 11.72 days in the open group, p = 0.529). An analysis based on the intention-to-treat with laparoscopy, including converted cases in the laparoscopic group, showed similar results, including overall complication rate (48.6 vs. 45.6%, p = 0.68) and Clavien–Dindo score in both minor (p = 0.24) and major complications (p = 0.44). Length of stay (10.92 vs. 11.81 days, p = 0.45) was also similar between the two groups.

Conclusion

In this series, a laparoscopic approach to Hartmann’s reversal did not offer any short-term advantage when compared to an open surgical approach.

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Title: Comparison between laparoscopic and open Hartmann’s reversal: results of a decade-long multicenter retrospective study
Authors: Nir Horesh
Yonatan Lessing
Yaron Rudnicki
Ilan Kent
Haguy Kammar
Almog Ben-Yaacov
Yael Dreznik
Shmuel Avital
Eli Mavor
Nir Wasserberg
Hanoch Kashtan
Joseph Klausner
Mordechai Gutman
Oded Zmora
Hagit Tulchinsky
Publication date: 01-12-2018
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 12/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-018-6227-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparison between laparoscopic and open Hartmann’s reversal: results of a decade-long multicenter retrospective study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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