Open AccessLaparoscopic Hartmann's reversal has better clinical outcomes compared to open surgery: An international multicenter cohort study involving 502 patients
Author(s) -
Medellin Abueta Anwar,
Senejoa Nairo Javier,
Pedraza Ciro Mauricio,
Fory Lina,
Rivera Carlos Perez,
Jaramillo Carlos Edmundo Martinez,
Barbosa Lina Maria Mateus,
Varela Heinz Orlando Ibañez,
Carrera Javier A.,
Garcia Duperly Rafael,
Sanchez Luis A,
LozadaMartinez Ivan David,
CabreraVargas Luis Felipe,
Mendoza Andres,
Cabrera Paulo,
Sanchez Ussa Sebastian,
Paez Cristian,
Wexner Steven D.,
Strassmann Victor,
DaSilva Giovanna,
Di Saverio Salomone,
Birindelli Arianna,
Florez Roberto Jose Rodríguez,
Kestenberg Abraham,
Obando Rodallega Alexander,
Robles Juan Carlos Sánchez,
Carrasco Carlos Adrian Niño,
Impagnatiello Alessio,
Cassini Diletta,
Baldazzi Gianandrea,
Roscio Francesco,
Liotta Gianluca,
Marini Pierluigi,
Gomez Daniel,
Figueroa Avendaño Carlos Edgar,
Villamizar Daniela Moreno,
Cabrera Laura,
Reyes Juan Carlos,
NarvaezRojas Alexis
Publication year - 2022
Publication title -
health science reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.462
H-Index - 7
ISSN - 2398-8835
DOI - 10.1002/hsr2.788
Subject(s) - medicine , perioperative , surgery , colostomy , perforation , retrospective cohort study , incidence (geometry) , diverticular disease , laparoscopy , cohort , materials science , punching , physics , optics , metallurgy
Abstract Background Hartmann's procedure (HP) is used in surgical emergencies such as colonic perforation and colonic obstruction. “Temporary” colostomy performed during HP is not always reversed in part due to potential morbidity and mortality associated with reversal. There are several contributing factors for patients requiring a permanent colostomy following HP. Therefore, there is still some discussion about which technique to use. The aim of this study was to evaluate perioperative variables of patients undergoing Hartmann's reversal using a laparoscopic and open approach. Methods The multicenter retrospective cohort study was done between January 2009 and December 2019 at 14 institutions globally. Patients who underwent Hartmann's reversal laparoscopic (LS) and open (OS) approaches were evaluated and compared. Sociodemographic, preoperative, intraoperative variables, and surgical outcomes were analyzed. The main outcomes evaluated were 30‐day mortality, length of stay, complications, and postoperative outcomes. Results Five hundred and two patients (264 in the LS and 238 in the OS group) were included. The most prevalent sex was male in 53.7%, the most common indication was complicated diverticular disease in 69.9%, and 85% were American Society of Anesthesiologist (ASA) II‐III. Intraoperative complications were noted in 5.3% and 3.4% in the LS and OS groups, respectively. Small bowel injuries were the most common intraoperative injury in 8.3%, with a higher incidence in the OS group compared with the LS group (12.2% vs. 4.9%, p < 0.5). Inadvertent injuries were more common in the small bowel (3%) in the LS group. A total of 17.2% in the OS versus 13.3% in the LS group required intensive care unit (ICU) admission ( p = 0.2). The most frequent postoperative complication was ileus (12.6% in OS vs. 9.8% in LS group, p = 0.4)). Reintervention was required mainly in the OS group (15.5% vs. 5.3% in LS group, p < 0.5); mortality rate was 1%. Conclusions Laparoscopic Hartmann's reversal is safe and feasible, associated with superior clinical outcomes compared with open surgery.