Single-port laparoscopic reversal of Hartmann's procedure through the colostomy site: technical aspects and early postoperative outcomes.

Abstract

Background: Single-port laparoscopic surgical approaches offer improved cosmetic outcomes and enhance recovery following surgery. The purpose of the study was to assess the reliability and efficacy of a single-port laparoscopic Hartmann's reversal(SPL-HR) through the colostomy site.

Methods: Prospective data from consecutive patients who underwent SPL-HR between 2020 and 2024 was analysed. Once the colostomy was detached from abdominal wall, a single-port device was introduced through the colostomy site. After mobilizing the rectal stump and afferent colon, colorectal anastomosis was carried out using a circular stapler transanally under laparoscopic vision. Postoperative care and discharge decisions were made following the ERAS protocol. Patient demographics, details of Hartmann's procedure, intraoperative outcomes, and early postoperative outcomes were evaluated.

Results: SPL-HR was successfully performed in 23 of 27 patients (85.1%), with a median operation time of 92 (50-172) min and a median blood loss of 100 (10-360) mL. Five patients (21.7%) experienced a postoperative complication. Two of them experienced grade 3a complications according to Clavien-Dindo classification: one with an intraabdominal abscess and one with a hematoma at the colostomy site, both requiring drainage under local anaesthesia. Anastomotic leak or mortality wasn't observed in patients. Functional recovery measures such as first flatus time and time to resuming a soft diet were favourable, with a median length of hospital stay of 4 (2-9) days.

Conclusion: The SPL-HR technique is a reliable and efficient method that is easy to perform. It has acceptable complication rates while improving postoperative recovery and reducing the length of hospital stay.