SP1.12 Laparoscopic Hartmann’s procedure for diverticular perforation reduces length of stay and mortality

Abstract

Abstract Introduction Hartmann's procedure for perforated diverticular disease is a common emergency abdominal operation; with a mean length of stay of over 2 weeks and a mortality of 8%. This study looks at whether the laparoscopic approach is feasible and might lead to improved outcomes. Methods The national NELA dataset was interrogated to find patients undergoing Hartmann's procedure for diverticular disease. Data were analysed according to surgical approach, length of stay and 30-day mortality. Results Over a 4-year period, 4061 patients underwent Hartmann's procedure for diverticular disease; 459 (11%) were started laparoscopically, and 162 (4%) were completed laparoscopically. 30 of 176 acute hospitals performed over half of laparoscopic cases, and 139 of 176 hospitals performed fewer than 1 each year. Mean length of stay was 17 days after open Hartmann's versus 11 days after the laparoscopic approach. Mortality in the open group was 8.2% versus 5.2% if surgery was started laparoscopically, and 1.3% if surgery was completed laparoscopically. This relationship remained when only patients with a predicted NELA mortality of less than 10% were considered (2.5% versus 1.4%). Observed versus expected mortality in the open group was 0.95, versus 0.63 in those undergoing laparoscopic surgery. Conclusions The laparoscopic approach to Hartmann's procedure for diverticulitis is associated with shorter hospital stay and reduced mortality. There is undoubtedly bias from patient selection, but some hospitals offer laparoscopy in over 50% of cases, which at least gives them the option of performing a laparoscopic Hartmann's if necessary and possible.