• Surgical endoscopy · Jul 2009

    Laparoscopic Hartmann's procedure: a viable option for treatment of acutely perforated diverticultis.

    • Emmanuel A Agaba, Raza M Zaidi, Peter Ramzy, Muhammad Aftab, Eugene Rubach, Gary Gecelter, Thanjur S Ravikumar, and George DeNoto.
    • Department of Surgery, North Shore-LIJ Health System, North Shore University Hospital, Manhasset, NY 11030, USA. eagaba@gmail.com
    • Surg Endosc. 2009 Jul 1; 23 (7): 1483-6.

    BackgroundA laparoscopic technique for acutely perforated diverticulitis (i.e., laparoscopic Hartmann's procedure) has not been described. The authors present their technique for laparoscopic sigmoid resection, end colostomy, and subsequent laparoscopic takedown of colostomy.MethodsA retrospective review of patients with Hinchey III/IV diverticulitis who underwent a laparoscopic Hartmann's procedure was performed in this study. Laparoscopic takedown of sigmoid colostomy was performed 2 to 3 months later. Data from these procedures including estimated blood loss (EBL), length of the operative procedure, patient outcomes, and demographics were evaluated.ResultsSeven patients with a mean age of 49.7 years underwent laparoscopic sigmoid colectomy with end colostomy. None of these patients had a history of diverticulitis. Their mean EBL was 138 ml, and their mean operative time was 154 min. None of the procedures required conversion to use of a hand port or conversion to open procedure. The average time to return of bowel function was 3.7 days, with one patient experiencing a postoperative ileus. The mean postoperative hospital stay was 6.6 days. There were no complications. Laparoscopic Hartmann's takedown was performed for all the patients approximately 2 to 3 months later. The mean EBL was 107 ml, and the average operative time was 189 min. One patient had intraoperative anastomotic leak, which was successfully repaired and retested. Again, none of the procedures required the use of a hand port or a laparotomy. The average time to return of bowel function was 3.4 days. The average length of hospital stay was 5.3 days, with one patient experiencing a fat necrosis.ConclusionsLaparoscopic Hartmann's procedure and laparoscopic takedown are technically feasible procedures with reasonable outcomes.

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