TY - JOUR
T1 - Laparoscopic Hartmann's reversal has better clinical outcomes compared to open surgery
T2 - An international multicenter cohort study involving 502 patients
AU - Medellin Abueta, Anwar
AU - Senejoa, Nairo Javier
AU - Pedraza Ciro, Mauricio
AU - Fory, Lina
AU - Rivera, Carlos Perez
AU - Jaramillo, Carlos Edmundo Martinez
AU - Barbosa, Lina Maria Mateus
AU - Varela, Heinz Orlando Ibañez
AU - Carrera, Javier A
AU - Garcia Duperly, Rafael
AU - Sanchez, Luis A
AU - Lozada-Martinez, Ivan David
AU - Cabrera-Vargas, Luis Felipe
AU - Mendoza, Andres
AU - Cabrera, Paulo
AU - Sanchez Ussa, Sebastian
AU - Paez, Cristian
AU - Wexner, Steven D
AU - Strassmann, Victor
AU - DaSilva, Giovanna
AU - Di Saverio, Salomone
AU - Birindelli, Arianna
AU - Florez, Roberto Jose Rodríguez
AU - Kestenberg, Abraham
AU - Obando Rodallega, Alexander
AU - Robles, Juan Carlos Sánchez
AU - Carrasco, Carlos Adrian Niño
AU - Impagnatiello, Alessio
AU - Cassini, Diletta
AU - Baldazzi, Gianandrea
AU - Roscio, Francesco
AU - Liotta, Gianluca
AU - Marini, Pierluigi
AU - Gomez, Daniel
AU - Figueroa Avendaño, Carlos Edgar
AU - Villamizar, Daniela Moreno
AU - Cabrera, Laura
AU - Reyes, Juan Carlos
AU - Narvaez-Rojas, Alexis
N1 - Publisher Copyright:
© 2022 The Authors. Health Science Reports published by Wiley Periodicals LLC.
PY - 2022/9
Y1 - 2022/9
N2 - Background: Hartmann's procedure (HP) is used in surgical emergencies such as colonic perforation and colonic obstruction. “Temporary” colostomy performed during HP is not always reversed in part due to potential morbidity and mortality associated with reversal. There are several contributing factors for patients requiring a permanent colostomy following HP. Therefore, there is still some discussion about which technique to use. The aim of this study was to evaluate perioperative variables of patients undergoing Hartmann's reversal using a laparoscopic and open approach. Methods: The multicenter retrospective cohort study was done between January 2009 and December 2019 at 14 institutions globally. Patients who underwent Hartmann's reversal laparoscopic (LS) and open (OS) approaches were evaluated and compared. Sociodemographic, preoperative, intraoperative variables, and surgical outcomes were analyzed. The main outcomes evaluated were 30-day mortality, length of stay, complications, and postoperative outcomes. Results: Five hundred and two patients (264 in the LS and 238 in the OS group) were included. The most prevalent sex was male in 53.7%, the most common indication was complicated diverticular disease in 69.9%, and 85% were American Society of Anesthesiologist (ASA) II-III. Intraoperative complications were noted in 5.3% and 3.4% in the LS and OS groups, respectively. Small bowel injuries were the most common intraoperative injury in 8.3%, with a higher incidence in the OS group compared with the LS group (12.2% vs. 4.9%, p < 0.5). Inadvertent injuries were more common in the small bowel (3%) in the LS group. A total of 17.2% in the OS versus 13.3% in the LS group required intensive care unit (ICU) admission (p = 0.2). The most frequent postoperative complication was ileus (12.6% in OS vs. 9.8% in LS group, p = 0.4)). Reintervention was required mainly in the OS group (15.5% vs. 5.3% in LS group, p < 0.5); mortality rate was 1%. Conclusions: Laparoscopic Hartmann's reversal is safe and feasible, associated with superior clinical outcomes compared with open surgery.
AB - Background: Hartmann's procedure (HP) is used in surgical emergencies such as colonic perforation and colonic obstruction. “Temporary” colostomy performed during HP is not always reversed in part due to potential morbidity and mortality associated with reversal. There are several contributing factors for patients requiring a permanent colostomy following HP. Therefore, there is still some discussion about which technique to use. The aim of this study was to evaluate perioperative variables of patients undergoing Hartmann's reversal using a laparoscopic and open approach. Methods: The multicenter retrospective cohort study was done between January 2009 and December 2019 at 14 institutions globally. Patients who underwent Hartmann's reversal laparoscopic (LS) and open (OS) approaches were evaluated and compared. Sociodemographic, preoperative, intraoperative variables, and surgical outcomes were analyzed. The main outcomes evaluated were 30-day mortality, length of stay, complications, and postoperative outcomes. Results: Five hundred and two patients (264 in the LS and 238 in the OS group) were included. The most prevalent sex was male in 53.7%, the most common indication was complicated diverticular disease in 69.9%, and 85% were American Society of Anesthesiologist (ASA) II-III. Intraoperative complications were noted in 5.3% and 3.4% in the LS and OS groups, respectively. Small bowel injuries were the most common intraoperative injury in 8.3%, with a higher incidence in the OS group compared with the LS group (12.2% vs. 4.9%, p < 0.5). Inadvertent injuries were more common in the small bowel (3%) in the LS group. A total of 17.2% in the OS versus 13.3% in the LS group required intensive care unit (ICU) admission (p = 0.2). The most frequent postoperative complication was ileus (12.6% in OS vs. 9.8% in LS group, p = 0.4)). Reintervention was required mainly in the OS group (15.5% vs. 5.3% in LS group, p < 0.5); mortality rate was 1%. Conclusions: Laparoscopic Hartmann's reversal is safe and feasible, associated with superior clinical outcomes compared with open surgery.
KW - colostomy
KW - laparoscopy
KW - laparotomy
KW - operative surgical procedures
KW - patient outcome assessment
UR - http://www.scopus.com/inward/record.url?scp=85138690994&partnerID=8YFLogxK
U2 - 10.1002/hsr2.788
DO - 10.1002/hsr2.788
M3 - Artículo
C2 - 36090626
SN - 2398-8835
VL - 5
SP - e788
JO - Health science reports
JF - Health science reports
IS - 5
M1 - e788
ER -