eP637 - Hartmann’s Reversal: Our Transition from Open to Laparoscopic in a Tertiary Referral Hospital at Mexico City

Purpose/Background: Hartmann’s reversal is one of the most frequently performed surgeries in the hospital environment; it is used to restore bowel continuity after a Hartmann’s operation. Previous studies have suggested that colostomy following an episode of acute diverticulitis or even after elective oncologic resection will not be reversed in almost 50% of patients. Such outcomes have been correlated with various factors related to the patient, morbidity and mortality of the surgery, and technical difficulties.Stoma reversal following Hartmann’s procedure may represent a hostile procedure. The current literature reports a mortality rate between 0.4% and 5%, and a morbidity rate of almost 50% following this surgery.Hartmann reversal via the laparoscopic approach is one of the most complex procedures performed laparoscopically, and it also results in a steep learning curve as well as a higher level of technical skill. Nevertheless, multiple studies have revealed better results when compared to the open approach. This study aimed to evaluate the multiple benefits offered by Hartmann’s reversal laparoscopic approach in comparison with the open approach and provide information and guidance to surgeons.Methods/Interventions: A retrospective review of patients who underwent Hartmann's reversal using a laparoscopic and open approach between March 2022 and August 2023 was conducted at a tertiary medical center in Mexico City. Demographic, intraoperative, and outcome data were assessed and analyzed.Results/Outcomes: Twenty-one patients (14 male and 7 female) underwent Hartmann’s reversal; ten procedures were performed laparoscopically, nine via an open approach and two converted procedures. The mean age and BMI were 42 years (21 - 64) and 24.88kg/m² (18.7-32.6). Two laparoscopic procedures were converted to open procedure due to technical complexity. The mean operative time was 271 minutes for the laparoscopic approach (133–502) and 237 minutes for the open approach (170 – 420); the mean estimated blood loss was 305 and 256 ml for the open and laparoscopic approaches, respectively. The mean length of stay was 10.2 days (6-23). There were no intraoperative complications; postoperative complications included anastomotic leak and bowel obstruction in the open approach group and bowel obstruction and DVT in the laparoscopic approach group. There were two readmissions and reinterventions in the open approach group and two readmissions with one reintervention in the laparoscopic group. No ICU admissions or mortalities were reported.Conclusion/

Discussion: Hartmann's reversal procedures have generally positive outcomes, with a significant improvement in patients' quality of life. Although the procedure carries potential risks and complications, careful patient selection and surgical expertise can significantly enhance the likelihood of successful outcomes. The laparoscopic approach resulted in a shorter length of hospital stay, less estimated blood loss, and low complication rates. Further research and advancements in surgical techniques will continue to refine this procedure, allowing more patients to benefit from its positive effects."Male & Female frecuency

Twenty-one patients (14 male and 7 female) underwent Hartmann’s reversal
Approach frequency

Eleven procedures were performed laparoscopically approach, and nine via an open approach and two converted procedures
Complications frequency

Postoperative complications included anastomotic leak and bowel obstruction in the open approach group and bowel obstruction and DVT in the laparoscopic approach group. There were two readmissions and reinterventions in the open approach group and two readmissions with one reintervention in the laparoscopic group"