Restitution of the Hartmann procedure by laparoscopic. Analysis of our experience at the Hospital Maciel, Montevideo, Uruguay, Surgical Clinics 2 and 3, Faculty of Medicine, University of the Republic (UDELAR)

Abstract

Background:

Described almost 100 years ago, the Hartmann procedure is still valid, being the classical behavior adopted for the management of the left colon in the emergency room. The restitution of the intestinal transit provides an important improvement in the quality of life of the patients, nevertheless given the high morbimortality, only half is reconstructed. Laparoscopic Hartmann restitution offers all the advantages of minimally invasive procedures with morbidity and mortality comparable to conventional surgery.

Objectives:

Analyze surgical technique and the results of a series of patients in whom laparoscopic Hartmann restitution was performed.

Material and methods:

Retrospective review was conducted between March 2002 and January 2017. The population belongs to the Surgical Clinics of the Maciel Hospital (‘Q2’ and ‘Q3’), UDELAR Medical School, Montevideo, Uruguay.

Results:

Twenty-nine patients were operated: 10 women and 19 men. The most frequent pathologies that determined the Hartmann were linked to diverticular pathology (37.93%) or oncological (34.48%). The minimum time elapsed between the Hartmann and the reconstruction was 4 months. The operative times ranged from 107 to 240 min. The conversion rate was 24.1%. Major complications occurred in 6.90% and minor complications in 13.79%. There was no anastomotic leak. The hospital stay was 5.57 days. The mortality rate was 3.45%.

Conclusions:

Our results are consistent with the international literature, laparoscopic Hartmann restitution is a demanding but feasible, safe procedure that gives the patient the benefits of minimally invasive surgery.