eP653 - Robotic Hartmann’s Reversal: The Future Is Now

Purpose/Background: End colostomy reversal with colorectal anastomosis (Hartmann’s reversal) is a major operation that has been associated with significant postoperative morbidity. A few studies have previously demonstrated a benefit in laparoscopic Hartmann’s reversal over open surgery. However, conversion rates remain high due to adhesions and the complexity of re-operative pelvic surgery. The robotic platform’s improved optics and articulating instruments may limit the conversion rate, ultimately reducing surgical morbidity. The purpose of this study was to assess operative outcomes for both minimally invasive and open approaches to Hartmann’s reversal.Methods/Interventions: This retrospective study was conducted at a tertiary referral academic healthcare system. All patients older than 18, who underwent an open, laparoscopic, or robotic Hartmann’s reversal from 2018 to 2023 were included. The primary outcome was hospital length of stay (LOS). Secondary outcomes included conversion to open, estimated blood loss (EBL), overall complication rates, and time to return of bowel function.Results/Outcomes: A total of 200 patients were included in the study. Of them, 139 had an open Hartmann’s reversal, 30 had laparoscopic, and 31 had robotic surgery. Patients who underwent laparoscopic surgery were more frequently female (77% versus 51% in open and 58% in robotic cases, p=0.037). Otherwise, there were no significant differences among the three groups in age, BMI, ASA class, and baseline comorbidities. Time from index surgery to reversal was similar among groups. Robotic surgery resulted in significantly lower EBL (median of 78 cc versus 100 cc in laparoscopic and 150 cc in open cases, p < 0.001). Conversion to open was reduced in the robotic surgery arm 16% versus 57% in the laparoscopic group (p=0.001). The majority of conversions were secondary to intra-abdominal adhesions. No difference in total operative time was seen among groups. Robotic and laparoscopic surgery were associated with shorter hospital length of stay compared to open surgery (median of three days in both groups versus four days in the open group, p < 0.001) and shorter time from surgery to return of bowel function (median of two days in both groups versus three days in the open group, p=0.018). No statistically significant differences existed in post-operative outcomes including wound complications and leak rates. Overall complication rates were 25.9% in open, 26.7% in laparoscopic, and 12.9% in robotic cases (p=0.289).Conclusion/

Discussion: Minimally invasive Hartmann’s reversal is associated with shorter LOS, lower EBL, and faster return of bowel function compared to an open approach. Robotic Hartmann’s reversal is associated with lower EBL and a significant decrease in conversion rate compared to laparoscopic techniques. These findings support minimally invasive procedures while suggesting the robotic platform may allow surgeons to minimize conversion and preserve improved patient outcomes. A larger sample size is needed to investigate potential differences in postoperative outcomes between laparoscopic and robotic Hartmann’s reversal.