[Laparoscopic approach for intestinal passage reconstruction after Hartmann's operation: experience with 30 patients]

Introduction: Intestinal passage reconstruction after Hartmann's (PRH) operation is associated with a high morbidity and mortality of about 1%. Despite the increasing use of laparoscopy as an alternative in PRH, there is a lack of patient series at international level.

Patients and methods: The prospective series of patients subjected to (PRH) by laparoscopy was analysed using the demographic parameters, ASA classification, reason for primary surgery, time between initial surgery and reconstruction, operation time, conversion to open surgery, bowel rest recovery time, complications, hospital stay and follow up.

Results: A total of 30 patients with a mean age of 61.5 ± 13 years were operated on using laparoscopy. The ASA classification was 1.8 ± 0.3 the BMI was 26.1 ± 2 Kg/m(2). A total of 63% were admitted due to complicated Hinchley III or IV acute diverticulitis. The interval between initial surgery and the passage reconstruction was 7.1 ± 2 months. Conversion to open surgery was necessary in three cases. The mean intestinal passage recovery was 2.1 ± 1 days and the hospital stay was 5.6 ± 1 days. The long-term complications were one mechanic ileum due to bridles and one case of anastomotic stenosis.

Conclusions: The post-Hartmann laparoscopic passage reconstruction is associated with a short intestinal motility recovery time, as well as a less prolonged hospital stay compared to an open surgery series. Randomised studies are needed to determine whether laparoscopic reconstruction is superior to the conventional technique.