Brief Article
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World J Gastrointest Surg. Aug 27, 2013; 5(8): 245-251
Published online Aug 27, 2013. doi: 10.4240/wjgs.v5.i8.245
Comparison between open and laparoscopic reversal of Hartmann’s procedure for diverticulitis
Nicola de’Angelis, Francesco Brunetti, Riccardo Memeo, Jose Batista da Costa, Anne Sophie Schneck, Maria Clotilde Carra, Daniel Azoulay
Nicola de’Angelis, Francesco Brunetti, Riccardo Memeo, Jose Batista da Costa, Anne Sophie Schneck, Daniel Azoulay, Digestive and Transplant Liver Surgery Unit, Henri-Mondor Hospital, Université Paris Est, 94010 Créteil, France
Maria Clotilde Carra, Department of Dentistry, Rothschild Hospital, 75012 Paris, France
Author contributions: de’Angelis N and Brunetti F contributed to the study conception, analysis, data interpretation, and drafting and final revisions of the manuscript; Memeo R and Carra MC contributed to data analysis, drafting and revision of the manuscript; Batista da Costa J and Schneck AS contributed to data acquisition and drafting; Azoulay D contributed to study conception, criticism, and final revision of the manuscript; All authors approved the final version of the manuscript.
Correspondence to: Nicola de’Angelis, MD, Research Fellow, Digestive and Transplant Liver Surgery Unit, Henri-Mondor Hospital, Université Paris Est, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France. nic.deangelis@yahoo.it
Telephone: +33-1-49812348 Fax: +33-1-49812432
Received: May 25, 2013
Revised: July 12, 2013
Accepted: July 17, 2013
Published online: August 27, 2013
Processing time: 94 Days and 14.5 Hours
Abstract

AIM: To compare the open and laparoscopic Hartmann’s reversal in patients first treated for complicated diverticulitis.

METHODS: Forty-six consecutive patients with diverticular disease were included in this retrospective, single-center study of a prospectively maintained colorectal surgery database. All patients underwent conventional Hartmann’s procedures for acute complicated diverticulitis. Other indications for Hartmann’s procedures were excluded. Patients underwent open (OHR) or laparoscopic Hartmann’s reversal (LHR) between 2000 and 2010, and received the same pre- and post-operative protocols of cares. Operative variables, length of stay, short- (at 1 mo) and long-term (at 1 and 3 years) post-operative complications, and surgery-related costs were compared between groups.

RESULTS: The OHR group consisted of 18 patients (13 males, mean age ± SD, 61.4 ± 12.8 years), and the LHR group comprised 28 patients (16 males, mean age 54.9 ± 14.4 years). The mean operative time and the estimated blood loss were higher in the OHR group (235.8 ± 43.6 min vs 171.1 ± 27.4 min; and 301.1 ± 54.6 mL vs 225 ± 38.6 mL respectively, P = 0.001). Bowel function returned in an average of 4.3 ± 1.7 d in the OHR group, and 3 ± 1.3 d in the LHR group (P = 0.01). The length of hospital stay was significantly longer in the OHR group (11.2 ± 5.3 d vs 6.7 ± 1.9 d, P < 0.001). The 1 mo complication rate was 33.3% in the OHR (6 wound infections) and 3.6% in the LHR group (1 hemorrhage) (P = 0.004). At 12 mo, the complication rate remained significantly higher in the OHR group (27.8% vs 10.7%, P = 0.03). The anastomotic leak and mortality rates were nil. At 3 years, no patient required re-intervention for surgical complications. The OHR procedure had significantly higher costs (+56%) compared to the LHR procedure, when combining the surgery-related costs and the length of hospital stay.

CONCLUSION: LHR appears to be a safe and feasible procedure that is associated with reduced hospitality stays, complication rates, and costs compared to OHR.

Keywords: Hartmann’s procedure; Hartmann’s reversal; Diverticular disease; Laparoscopy; Healthcare-related costs; Colorectal surgery

Core tip: The present study examined the intra-operative and post-operative clinical outcomes of open vs laparoscopic Hartmann’s reversal in patients first treated for diverticulitis, one of the most common gastrointestinal diseases. By selecting a homogeneous sample of patients, we are able to describe the advantages of laparoscopy in this specific population. The laparoscopic reversal of Hartmann’s procedure appeared to be safe and feasible, with advantages in reduced hospitality stays, complication rates, and heath-related costs compared to the open approach.