Laparoscopic reversal after acute open Hartmann’s procedure (video)

Abstract

Introduction:  Hartmann’s procedure remains as a safe option in the management of acute abdomen, such as colonic obstruction. However, subsequent reversal can be challenging in some clinical settings as morbid obese patients and extensive intraperitoneal adhesions.

Description: 39 year-old male, morbid obesity, who underwent open Hartmann’s procedure one year before due to sigmoid diverticular obstruction. Preoperative assessment revealed the presence of a 35 cm distal rectosigmoid stump. After primary ostomy release, anvil of the circular stapler is placed and colon reintroduced, checking for midline adherences in order to achieve a safe first port introduction and the rest of them under direct vision. Distal stump is identified and released, and proximal colon is mobilized without the need - in this particular case - of inferior mesenteric vessels ligation and/or splenic flexure descent. Sigmoid remnant is resected for anatomic and technical reasons. The first, to avoid diverticular disease in a young patient that was already operated with a complication of it; and the second, to ease the construction of a mechanical end-to-end colorectal anastomosis.

Finally, air leak test is performed and pelvic drain is placed. Placement of 2 additional ports was needed because of this patient’s morbid obesity.

There were no complications during postoperative (PO) course, drain was removed 72 hours after and hospital discharge on 5th PO day.

Conclusion: This case clearly exemplifies that laparoscopic reversal of an open Hartmann’s procedure is feasible, safe and offers the minimally invasive surgery advantages.