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

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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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Acknowledgements

The authors thank Esther Eshkol for editorial assistance and Prof. Andrew P. Zbar for his support.

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Authors and Affiliations

  1. Department of General Surgery and Transplantations B, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel

    Nir Horesh, Yael Dreznik, Mordechai Gutman & Oded Zmora

  2. Division of Surgery, Tel-Aviv Medical Center, Tel Aviv, Israel

    Yonatan Lessing, Joseph Klausner & Hagit Tulchinsky

  3. Department of Surgery B, Meir Medical Center, Kfar Saba, Israel

    Yaron Rudnicki, Ilan Kent & Shmuel Avital

  4. Department of Surgery, Kaplan Medical Center, Rehovot, Israel

    Haguy Kammar & Eli Mavor

  5. Department of Surgery B, Rabin Medical Center, Petah Tikva, Israel

    Almog Ben-Yaacov, Nir Wasserberg & Hanoch Kashtan

  6. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

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

  7. School of Medicine, Hadassah-Hebrew University, Jerusalem, Israel

    Haguy Kammar

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  1. Nir Horesh
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  2. Yonatan Lessing
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Contributions

NH, NW, OZ, HT: design of the work, drafting the manuscript, final approval of the version to be published, accountable for all aspects of the work. NH, YL, YR, IK, YD, HK, AB-Y: data collection, final approval of the version to be published, accountable for all aspects of the work. SA, EM, HK, JK, MG: interpretation of data for the work, drafting the manuscript, final editing and approval of the version to be published, accountable for all aspects of the work. There is no grant support or financial relationship related to this manuscript on the part of any of the authors.

Corresponding author

Correspondence to Nir Horesh.

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Disclosures

Nir Horesh, Yonatan Lessing, Yaron Rudnicki, Ilan Kent, Haguy Kammar, Almog Ben-Yaacov, Yael Dreznik, Shmuel Avital, Eli Mavor, Nir Wasserberg, Hanoch Kashtan, Joseph M. Klausner, Mordechai Gutman, Oded Zmora, and Hagit Tulchinsky have no conflict of interest or financial ties to disclose.

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Horesh, N., Lessing, Y., Rudnicki, Y. et al. Comparison between laparoscopic and open Hartmann’s reversal: results of a decade-long multicenter retrospective study. Surg Endosc 32, 4780–4787 (2018). https://doi.org/10.1007/s00464-018-6227-8

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