Laparoscopically assisted Hartman's reversal is an efficacious and efficient procedure: a case control study.

Objective: Laparoscopy may lower the mortality and morbidity rates of Hartmann's procedure reversal. However, it remains a challenging operation mainly due to adhesions of the small bowel and to the rectal stump.

Methods: We performed a retrospective review of 44 patients who had laparoscopic Hartmann's reversal (Group A). On a case-control basis, these patients were compared to 44 patients (Group B) who had open Hartmann's reversal.

Results: Preoperative patients' characteristics (sex, gender, BMI, ASA status, prior surgery, comorbidities, colonic disease) were comparable. Conversion rate in Group A was 9.1%. Operative incidents were comparable in both groups. Operative duration was not significantly shorter in Group B (195 min versus 160 min in Group B). Mortality rate was 2.2 % and O % in group A and B, respectively. Overall morbidity rate was 11.4 % and 28.6 % in Group A and B, respectively (P<0.05). The mean length of hospital stay was significantly shorter in Group A (4.8 days) as compared to Group B (6.8 days), respectively. An efficiency analysis was performed and demonstrated that laparoscopic reversal did not generate a significant additional cost.

Conclusions: Our laparoscopic technique of Hartmann's procedure reversal is safe and efficient. It compares positively with the same procedure performed openly in a case control study. Moreover, an indirect cost reduction is generated by the reduction of the length of hospital stay.