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Efficacy and Safety of Laparoscopic Hartmann Colostomy Reversal

Annals of Coloproctology 2018년 34권 6호 p.306 ~ 311
박원, 박원철, 김근영, 이석윤,
소속 상세정보
박원 ( Park Won ) - Wonkwang University School of Medicine Department of Surgery
박원철 ( Park Won-Cheol ) - Wonkwang University School of Medicine Department of Surgery
김근영 ( Kim Keun-Young ) - Wonkwang University School of Medicine Department of Surgery
이석윤 ( Lee Seok-Youn ) - Wonkwang University School of Medicine Wonkwang University Sanbon Hospital Department of Surgery

Abstract


Purpose: Hartmann operation is widely recognized as a useful procedure, especially in emergencies involving the rectosigmoid colon. One of the surgeon’s foremost concerns after Hartmann operation is future colostomy reversal, as colostomy reversal after a Hartmann procedure is associated with relatively high morbidity and mortality. Laparoscopic surgical techniques continue to prove useful for an ever-increasing variety of indications. We analyzed the outcomes of laparoscopic Hartmann colostomy reversals at our center.

Methods: We retrospectively analyzed the hospital records of 170 patients who had undergone Hartmann operation between January 2010 and June 2017 at Wonkwang University Hospital. Among 68 Hartmann colostomy reversals, we evaluated and compared the outcomes of 3 groups of patients: 29 patients in the open colostomy reversal group (OG) who had undergone laparotomies for Hartmann reversals, 19 patients in the conversion group (CG) whose laparoscopic procedures had required conversion to a laparotomy, and 20 patients in the laparoscopy group (LG).

Results: The overall reversal rate for Hartmann colostomies was 40.5% during this time period. The duration of hospital stay was significantly shorter among LG patients (10.15 ± 2.94 days) than among OG patients (16 ± 9.5 days). The overall complication rate among OG patients was higher than that among LG patients (adjusted odds ratio, 8.78; P = 0.01). The most common complication was postoperative ileus (19.1%).

Conclusion: If no contraindications to laparoscopy exist, surgeons should favor a laparoscopic reversal of Hartmann operation over an open reversal.

키워드

Colostomy; Hartmann operation; Laparoscopy

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