Laparoscopic-assisted colostomy closure after Hartmann's procedure.

PURPOSE: The aim of the study was to review our experience with colostomy closure after Hartmann's procedure and the possible impact of laparoscopic colostomy closure.

METHODS: A retrospective review of hospital stay after colostomy closure by laparotomy in the last four years was conducted. A chart review of patients undergoing laparoscopic colostomy closure after Hartmann's procedure since the introduction of operative laparoscopy at our institution was also done.

RESULTS: One hundred twenty patients had colostomy closure carried out by the trauma service at the University of Miami/Jackson Memorial Hospital. In thirty-seven patients, colostomy closure was associated with other surgical procedures such as ventral herniorrhaphy, delayed closure of the open abdomen, ureteroneocytostomy, and so forth, or they underwent loop colostomy closure. These patients were excluded from further review. Sixty-five patients underwent reversal of Hartmann's procedure by laparotomy. They had an average hospital stay of 9.5 days (range, 6 to 34 days). This group of patients had colostomy closure prior to the introduction of operative laparoscopy in our institution. With increased laparoscopy experience, laparoscopically assisted Hartmann's reversal has been attempted in 18 patients and completed in 14 patients. The average hospital stay in the laparoscopically completed group was 6.3 days (range, 4 to 10 days). This group had a 0 percent mortality and a 14.3 percent morbidity. This compares favorably to recently reported series of colostomy closure by laparotomy.

CONCLUSION: Laparoscopically assisted Hartmann's reversal results in comparable morbidity, but may be associated with shorter hospital stay when compared with laparotomy.