Laparoscopic Hartmann reversal: Video presentation of a case


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Abstract

Introduction:Laparoscopic Hartmann reversal (LHR) has decreased postoperative recovery time and a lower wound infection rate compared to open HR. However its technical difficulty and high conversion rates make it a challenging procedure. We aim to demonstrate the technique of LHR via a video presentation. Our patient, a 64 year old Chinese man with no history of previous surgery underwent a Hartmann procedure for an obstructing sigmoid stricture secondary to diverticular disease. Three months later, he underwent an elective LHR.Materials and Surgical Technique:A 10 mm port was initially inserted in the right iliac fossa under direct vision away from expected adhesions due to the previous midline incision. Additional 5mm working ports were inserted in the right flank and right hypochondrium. An additional 10mm optical port was then inserted in the epigastrium and the laparoscopic camera was switched to the epigastric port. Omental adhesions to abdominal wall were taken down. The left colon was then brought down to the pelvis to ensure adequate length of bowel for anastomosis. A colorectal side to end anastomosis was then performed. The stoma wound was closed and the patient was discharged well on post-operative day 5.Discussion:LHR can be adopted as an initial approach to visualize intra-abdominal adhesions and determine feasibility of operation. With experienced hands, LHR can achieve good patient outcomes.

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