Reversal of Hartmann’s procedure – Is Single incision laparoscopic reversal the way forward?

Reversal of Hartmann’s procedure (RoH) is known to be associated with considerable amount of morbidity and can be quite a challenge both to the patient and the surgeon. In recent years Single incision laparoscopic surgery (SIL) has tried as feasible minimally invasive operation. This is the largest case series of RoH, that has been done to study associated benefits with SIL RoH. All patients who underwent SIL RoH at a single institution from Feb 2010 to Sept 2018 were included in this case series analysis. Any case of multiport or open reversal of Hartmann’s were excluded from this study. Patient characteristics, indications for index surgery, operative and post-operative outcomes were retrospectively analyzed from a prospectively maintained database. A total of 68 patients [29 females] were included in this series. 5 patients [7.3%] needed conversion to an open procedure and 1 patient required placement of an extra port. RoH was abandoned due to a fibrotic rectal stump in one patient. Surgical morbidity was classified as per Clavien-Dindo classification. Grade 3 and 4 complications were noted in 4 patients [5.8%] and Grade 5 in one patient [1.5%]. Post-operative hospital stay was a median of 4 days [range 2–44]. SIL RoH has its advantages over conventional methods of RoH. This series does demonstrate the feasibility and safety of using SIL approach for RoH in experienced hands.