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Technical aspects and outcome of a standardized full laparoscopic approach to the reversal of Hartmann’s procedure in a teaching centre
Author(s) -
Leroy J.,
Costantino F.,
Cahill R. A.,
D’Agostino J.,
Wu W. H. S.,
Mutter D.,
Marescaux J.
Publication year - 2011
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2010.02389.x
Subject(s) - medicine , outcome (game theory) , general surgery , medical physics , surgery , mathematical economics , mathematics
Aim Laparoscopic reversal of Hartmann’s procedure is technically demanding. We evaluated the technical aspects and outcome of a standardized approach in a single centre and examined the feasibility of including this into training curricula. Method The procedure entails a laparoscopy for adhesiolysis and identification and mobilization of the rectal stump. Mobilization of the splenic flexure is performed if necessary, and a colorectal anastomosis is fashioned after introduction of the stapler anvil via the colostomy with intra‐abdominal positioning and delivery into the proximal colonic segment to be anastomosed. The stoma is excised as the last step in the operation. Results Forty‐two patients underwent the procedure over an 8‐year period with either an expert ( n =21) or trainee under expert mentorship ( n =21) as first operator. Intra‐operative data and postoperative outcomes were evaluated by retrospective review of clinical charts and theatre records. There was a 9.5% conversion rate and 0% mortality. One patient suffered a ureteric injury, while postoperative surgical complications occurred in 7 patients (including one clinical anastomotic leakage). The mean operative time was 117 min. There was no significant difference in intra operative technical parameters or postoperative clinical consequences between procedures performed by a trained surgeon or by a trainee under mentorship. Conclusion Adherence to a standardized operative protocol and expert mentorship allows this technically demanding operation to be associated with low conversion and complication rates. The absence of any difference between procedures performed by a trainee or trained surgeon suggests that the operation can be included in training programmes for laparoscopic surgery.