VM97 - Laparoscopic Hartmann’s Reversal After Perforated Sigmoid Diverticulitis in a Female Patient

Purpose/Background: Anastomotic dehiscence and subsequent sepsis after an emergency colonic resection are complications responsible for significant morbidity and mortality. Hartmann’s procedure includes a left hemicolectomy and terminal colostomy during the emergency procedure, therefore omitting an anastomosis and avoiding the risk of a leak. Creation of the anastomosis is delayed until the reversal of the Hartmann's stoma. However, Hartmann’s reversal is associated with morbidity and mortality, commonly explained by significant post-inflammatory alterations and modified anatomy after previous bowel resection. Traditionally performed as an open procedure, the laparoscopic approach has gained increasing reconnaissance and was shown to be effective and safe in most patients.

Methods/Interventions: We present a step-by-step laparoscopic Hartmann’s reversal procedure in a 36-year-old woman, with a significantly altered anatomy of the female pelvis. The woman had undergone a laparoscopic Hartmann's procedure for perforated sigmoid diverticulitis 8 months prior.

Results/Outcomes: Reversal of the Hartmann’s stoma was performed, and a stapled end-to-end colorectal anastomosis was fashioned. Critical steps applied and shown in the video are the diagnostic laparoscopy through the colostomy site with clear annotation of the female anatomy, mobilization of the rectal stump, identification of the left ureter, mobilization of the descending colon, creation of the colorectal anastomosis, and performance of a leak test. Throughout the video, important anatomical landmarks are highlighted to facilitate orientation.

Conclusion/Discussion: Laparoscopic Hartmann’s reversal was shown to be safe and feasible in most patients. Patients with a high degree of inflammation and peritonitis at the time of the initial procedure are challenging. This video provides visual support in recognizing the female anatomy after Hartmann’s procedure for perforated diverticulitis and shows the feasibility of the laparoscopic approach.