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International Journal of Colorectal Disease

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22-11-2022 | Laparoscopy | Review

Open versus laparoscopic Hartmann’s procedure: a systematic review and meta-analysis

Authors: Yingjia Zhang, Chunxi Liu, Kameswara Rishi Yeshayahu Nistala, Choon Seng Chong

Published in: International Journal of Colorectal Disease | Issue 12/2022

Abstract

Purpose

Hartmann’s procedure is traditionally performed in emergency situations where single-step procedures with immediate anastomosis may be unsafe. However, it can be associated with significant morbidity and low colostomy reversal rate. Whilst randomised controlled trials and a Cochrane review have reported strong evidence of laparoscopic over open colectomies, no such reviews have been performed for Hartmann’s procedure. Hence, this paper aims to summarise the existing evidence to determine the efficacy of laparoscopic Hartmann’s procedure over its open counterpart.

Methods

Embase, Medline and Cochrane databases were searched from inception to 15 November 2020 for keywords relating to ‘laparoscopy’ and ‘Hartmann’ using strict inclusion and exclusion criteria. Odds ratio was estimated for dichotomous outcomes and weighted mean difference was estimated for continuous outcomes.

Results

From the 836 articles yielded from the search strategy, 12 articles were selected for meta-analysis. Pooled analysis revealed that laparoscopic Hartmann’s procedure (LHP) allows for a shorter length of stay, and a lower risk of overall surgical site infections and superficial surgical site infections. There was no significant difference in other outcomes. Single-arm analysis of LHP also showed an unprecedented high colostomy reversal rate of over 80%.

Conclusion

In clinically suitable patients, laparoscopic Hartmann’s procedure has benefits over open Hartmann’s procedure. Despite the selection bias of single-arm studies, LHP has reported a high stoma reversal rate of over 80%. Future well-controlled studies should be done to affirm the findings.

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Title: Open versus laparoscopic Hartmann’s procedure: a systematic review and meta-analysis
Authors: Yingjia Zhang
Chunxi Liu
Kameswara Rishi Yeshayahu Nistala
Choon Seng Chong
Publication date: 22-11-2022
Publisher: Springer Berlin Heidelberg
Keywords: Laparoscopy
Enterostomy
Enterostomy
Diverticulitis
Published in: International Journal of Colorectal Disease / Issue 12/2022
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-022-04285-6

At a glance: The STEP trials

Springer Medicine

Open versus laparoscopic Hartmann’s procedure: a systematic review and meta-analysis

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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