WP2.16 - Hartman’s Reversal; A comparison of conventional vs minimally invasive surgical approach

Abstract

Abstract Background Hartman’s procedure is a safe operation for emergency colonic resections. Hartman’s reversal, however, is a technically challenging operation with high morbidity. Hence, almost half of the patients choose to live with lifelong stoma. Hartman’s reversal can be done open or laparoscopic, with single incision laparoscopic surgery (SILS) as an emerging minimally invasive technique. We will discuss the different surgical techniques along with their results and challenges. Methods This is a single centre retrospective study done at District General Hospital. All the Hartman’s reversals done between July 2021 to July 2023 were included in the study. Demographics, primary disease, interval between primary operation and reversal, post-operative complications and hospital stay was calculated. Results A total number of 19 Hartman’s reversal operations were done between July 2021 to July 2023. Average age of the patients was 61.8 years. The pathology was cancer in 7 patients and 12 cases were benign. The average interval between Hartman’s procedure and reversal was 23.2 months. Only 3 (15.7%) patients had a co-morbid. Out of 19 Hartman’s reversals done, 11 (57.89%) were done open, 5 (26.3%) SILS, 1 (5.2%) laparoscopic, and 2 (10.5%) laparoscopic converted to open. The complication rate in open cases was 61.5% vs 33.33% in laparoscopic/SILS. Average length of stay (LOS) was 10.38 days in open vs 9.19 days in laparoscopic group. Conclusion The limitations of this study are single centre and low sample size. The length of stay is slightly better in minimally invasive group, and much better post-operative outcomes. We suggest a multicentre study can help establish more reliable results.