Laparoscopic reversal of the Hartmann procedure – a video vignette

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Abstract

The Hartmann procedure is a standard life‐saving operation for an acute left colonic complication 1. In the past it has been performed in cases with complicated inflammation of the left colon, bowel obstruction caused by colon cancers or in the case of insufficiency of anastomoses, or in urgent operations after traumatic bowel injuries, when making an anastomosis carries very high risk 2-4. It can generally be considered a temporary procedure with the intention of reversing it later on. The mean time interval between the initial procedure and the reversal is 181.6 days (range 95–330 days). The mortality rate is 0.7% and 16.6% of patients have postoperative complications 5. Hartmann’s is a challenging procedure, but if performed laparoscopically it has various advantages. Our patient, a 60‐year‐old Italian woman with a history of previous laparoscopic hysterectomy, underwent a laparoscopic Hartmann procedure for bowel perforation secondary to diverticular disease. Six months later she underwent an elective laparoscopic Hartmann reversal. The first step was the reduction of parastomal hernia (Video S1). The second step was mobilization of the splenic flexure. During the previous operation the splenic flexure was not mobilized, so the planes at this level were good. It is not mandatory to isolate the ureter. Usually the rectum is not isolated, but in this case thanks to the use of the handpiece of the circular stapler the wall of the rectum was exposed. The vagina was identified and moved away. The operation was completed with a mechanical circular anastomosis.

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