Transanal Hartmann’s colostomy reversal assisted by laparoscopy: outcomes of the first 10 patients
Autor: | Marta Jiménez-Toscano, Jean-Sébastien Trépanier, Antonio M. Lacy, Francisco B. DeLacy, María Fernandez-Hevia, Raquel Bravo, María Clara Arroyave |
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Rok vydání: | 2017 |
Předmět: |
Male
medicine.medical_specialty Ileus medicine.medical_treatment Operative Time Anal Canal Pilot Projects 030230 surgery Anastomosis 03 medical and health sciences Ileostomy Postoperative Complications 0302 clinical medicine Colostomy reversal Colostomy Humans Medicine Laparoscopy Aged Retrospective Studies Aged 80 and over medicine.diagnostic_test business.industry General surgery Anastomosis Surgical Rectum Surgical Stomas Length of Stay Middle Aged Diverticulitis medicine.disease Conversion to Open Surgery Surgery Treatment Outcome Female 030211 gastroenterology & hepatology business Abdominal surgery |
Zdroj: | Surgical Endoscopy. 31:4981-4987 |
ISSN: | 1432-2218 0930-2794 |
Popis: | Restoration of intestinal continuity after Hartmann’s procedure is a technically difficult surgery associated with significant morbidity and mortality. This study presents the short-term results of a new approach: a transanal Hartmann’s colostomy reversal assisted by laparoscopy. This is a retrospective analysis of data collected in one tertiary hospital, from October 2013 to November 2015. During the study period, there were ten cases of transanal Hartmann’s reversal. Reasons for Hartmann’s procedure were: complicated diverticulitis (4), anastomotic leak (3), and recto-sigmoid cancer (3). Rectal stump length was 10.4 ± 4.5 cm. Reconstruction was achieved in all patients. One low colorectal anastomosis was hand-sewn, the other 9 were stapled. Mean operative time was 204 ± 65 min. Diverting loop ileostomies were created in five patients and all were closed during the following year. One case required hand-assistance but there was no conversion to open surgery. Iatrogenic laparoscopic enterotomies occurred in four patients and all were repaired primarily without consequences. Three patients had a total of four post-operative complications: ileus (2), abdominal abscess and wound infection (1). None required reoperation. Mean length of stay was 7.2 ± 4.3 days. One required readmission. A transanal Hartmann’s reversal assisted by laparoscopy is a new approach for a difficult surgery. It has the potential to be an additional tool in the case of hostile pelvises or with a rectal stump difficult to identify. The surgery remains challenging and indications need to be clarified. |
Databáze: | OpenAIRE |
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