Laparoscopically Assisted Reversal of Hartmann's Pouch

Purpose. Restoration of bowel continuity after Hartmann's procedure is a major operation and is associated with increased morbidity and mortality, especially in elderly patients and in those in a poor condition. Our aim was to evaluate laparoscopically assisted reversal of Hartmann's pouch in a case series of patients. Methods. Aretrospective review of patients who underwent laparoscopically assisted reversal of Hartmann's pouch was performed between January 2002 and January 2005. All 10 patients were diagnosed with perforated diverticulitis of left sided colon and were initially treated by exploratory laparotomy with Hartmann's procedure. Results. Ten patients (9 men and 1 woman; mean age, 58.6 years) underwent laparoscopically assisted reversal of Hartmann's pouch. All patients were diagnosed with perforated diverticulitis at a mean time of 5.2 months after the initial operation. The mean operative time was 248.4 min, and the mean longest incision length was 5.3 cm. The mean estimated blood loss was 98.7 ml. No conversion to laparotomy was noted (0%). Intraoperative complications included 1 bowel injury and 1 bladder injury. Post-operative complications included 4 colostomy-site wound infections. There was no mortality associated with the procedure. Conclusions. Laparoscopically assisted reversal of Hartmann's pouch is technically challenging and time consuming. It has low operative morbidity and mortality. Conventional laparotomy is one choice for reversal of Hartmann's pouch, and laparoscopic reversal of Hartmann's pouch is another good choice. Laparoscopic reversal is our preferred approach for reversal of Hartmann's pouch.