Laparoskopische Kontinuitätswiederherstellung nach Hartmann-Situation: Ergebnisse einer Single-Center-Studie

Introduction: Thanks to increasing knowledge and experience in the field of laparoscopic colorectal interventions, previous open surgery and interenteric adhesions-as seen in Hartmann procedure patients-no longer represent contraindications. The goal of this study was to establish whether laparoscopy is an appropriate approach to restore continuity in the case of previous laparotomy, generally performed in an emergency setting, and whether it can contribute to reducing morbidity and mortality. Methods: Data on all patients who underwent laparoscopic restoration of continuity following a Hartmann procedure during the observation period from 01/2000 to 12/2010 at the Surgical Clinic of the University of Lübeck were collected. Data were retrospectively analysed. Particular attention was paid to the indication for discontinuity resection, intraoperative findings, surgery time, postoperative analgesic requirements, time to resumption of intestinal activity, period of hospitalization, as well as peri- and postoperative morbidity and mortality. Results: The principal indication for the Hartmann procedure was perforated sigmoid diverticulum. Laparoscopic restoration of continuity was performed in 19 patients. Three patients (15.7%) were converted intraoperatively. The median operating time was 202 (75-245) min, while postoperative analgesic requirements lasted on average for seven (6-7) days. Normal diet was resumed following three (2-16) days on average. Intestinal activity was resumed within three (2-4) days, while the average length of hospital stay was 10 (8-13) days. Postoperatively, three (15.7%) minor complications (2× pneumonia, 1× protracted intestinal atonia) and four (21%) major complications requiring surgical intervention (2× wound infection, 1× adhesion ileus and 1× trocar site hernia) were observed. The median follow-up was eight (1-20) months. There were no peri- or postoperative mortalities. Conclusion: The present study demonstrates the essential feasibility of laparoscopic therapy. However, a laparoscopic approach demands significant expertise of the operator and always requires a careful evaluation of the benefit/risk ratio on an individual basis.