Elie Chouillard. Paris West Medical Center
Background: Nearly a century after its first description, the Hartmann’s procedure (H1), consisting in a left colonic resection and concomitant terminal colostomy, is still popular worldwide. Laparoscopy may lower the mortality and morbidity rates of the Hartmann’s procedure reversal (H2). However, H2 remains a challenging operation mainly due to adhesions of the small bowel and to the difficulties in obtaining an adequate exposure of the rectal stump. The aim of this study was to report our experience with single-port laparoscopic reversal of the Hartmann's procedure (SPH2), comparing it to its multiport laparoscopic variant (MPH2).
Methods: We performed a retrospective review of 44 patients who had SPH2 (Group A) between December 2010 and March 2017. On a case-control basis, these patients were matched to and compared with 44 patients (Group B) who had MPH2 between January 2002 and November 2010.
Results: Preoperative patients’ characteristics (sex, gender, BMI, ASA status, prior surgery, comorbidities, colonic disease) were comparable in both groups. Conversion rate was 9.1 % and 4.5 % in Group A and in Group B, respectively (p<0.05). Mean operative duration was shorter in Group A (105 min) as compared to 160 min in Group B, (p<0.05). Mortality rate was 2.2 % and 0 % in Group A and B, respectively (p>0.05). Overall morbidity rate was 11.4 % and 18.2 % in Group A and B, respectively (p>0.05). The mean length of hospital stay was significantly shorter in Group A (4.8 days) as compared to Group B (6.8 days), (p>0.05). Additionally, the prevalence of incisional hernia at 12-months follow-up was 6.8 % in both groups.
Conclusions: Our SPH2 technique is safe and efficient. It compares positively with the more traditionally performed MPH2. Moreover, an indirect cost reduction is generated by the reduction of the length of hospital stay.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 91183
Program Number: ETP891
Presentation Session: Emerging Technology iPoster Session (Non CME)
Presentation Type: Poster