VIDEO

Laparoscopic reversal after urgent open Hartmann's procedure

Javier Chinelli, Gustavo Rodríguez

Clínica Quirúrgica 2, Hospital Maciel. Montevideo, Uruguay.

ABSTRACT

Introduction: Hartmann's procedure remains a current and safe option for the management of some urgent cases. However, reversal may be challenging in certain patients, such as the morbidly obese and those with extensive abdominal adhesions.

Description: A 39-year-old male patient, morbidly obese, with a history of open Hartmann's procedure one year earlier due to colonic diverticular obstruction, who underwent laparoscopic reversal, is presented. The preoperative assessment revelead a 35 cm rectosigmoid stump.

After stoma release, the anvil is placed, the colon is reintroduced, and the midline is investigated for adhesions to ensure secure placement of the first port. The distal stump is identified and released. The proximal colonic end is mobilized. The distal sigmoid remnant is resected for two reasons anatomical and technical reasons. The first, to avoid recurrence of diverticular disease; the second, for facilitating the stapled end-to-end colorectal anastomosis. Finnaly, the air leak test is performed and a pelvic drain is placed

The postoperative course was uneventful, the drain was removed 72 hours later and the patient was discharged on the 5th postoperative day.

Conclusion: Laparoscopic reversal after an open Hartmann's procedure is feasible, safe and offers the advantages of minimally invasive surgery.

Keywords: Hartmann's, reversal, laparoscopy

The authors declare no conflicts of interest.

Correspondence: Javier Chinelli: jchinelli01@gmail.com
Received: October 2022. Accepted: December 2022.

Javier Chinelli: https://orcid.org/0000-0003-2381-697X

Gustavo Rodriguez: https://orcid.org/0000-0003-3465-8364