Laparoscopic Hartmann's reversal: application of a single-port approach through the colostomy site.

Purpose: Recently, laparoscopic reversal of Hartmann colostomy was performed with favorable outcomes by many surgeons. We partially applied the concepts of single-port laparoscopic procedure through the colostomy site to remove intraperitoneal adhesion during initial step of the laparoscopic Hartmann reversal. This study aimed to evaluate the feasibility and safety of the laparoscopic reversal of Hartmann colostomy with the application of single-port laparoscopic techniques through the colostomy site.

Methods: From October 2008 to November 2018, the laparoscopic Hartmann reversal was attempted in 20 patients. After colostomy take-downs, the single-port device was installed at the colostomy site and the single-port laparoscopic procedure was performed to remove intraperitoneal adhesions to provide space for additional trocars. After additional trocars were inserted, the descending colon and rectal stump were mobilized, and the colorectal anastomosis was completed. We retrospectively reviewed the medical records and analyzed the data to identify the perioperative complication rates as the primary outcome.

Results: Of the 20 patients, 3 patients (15.0%) had open conversions due to severe adhesions. Intraoperative small bowel injuries occurred in 2 patients (10.0%) and these were repaired through the colostomy site. Postoperative complications developed in 4 patients (20.0%) and were managed with medical treatments or wound closures under local anesthesia.

Conclusion: The single-port laparoscopic procedure through the colostomy site is sufficiently safe in order to complete the Hartmann reversal. We recommend that the colostomy site should be used as the access route into the abdominal cavity for the Hartmann reversal.