A proactive technique for reversal of Hartmann's procedure: lifting the rectal stump to the abdominal wall.

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Techniques in Coloproctology Pub Date : 2025-03-24 DOI:10.1007/s10151-025-03128-0

A Fukada, T Ogino, Y Fujimoto, Y Sekido, M Takeda, T Hata, A Hamabe, N Miyoshi, M Uemura, T Mizushima, H Eguchi, Y Doki

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引用次数: 0

Abstract

Background: Reversing Hartmann's procedure is complicated owing to dense adhesions resulting from inflammation in the pelvic region. These adhesions pose challenges in identifying the rectum and increase the risk of pelvic organ injuries.

Methods: We propose a technique to lift and fix the rectal stump to the abdominal wall to diminish adhesions to the rectum and facilitate identification of the rectal stump.

Results: The patient underwent Hartmann's procedure for generalized peritonitis resulting from perforation of the sigmoid colon. The abdominal cavity was significantly contaminated with fecal ascites, and postoperative pelvic adhesions were anticipated. Therefore, the rectal stump was lifted. The outcomes demonstrated that despite the presence of dense adhesions in the abdominal cavity, the rectal segment was promptly identified during the reversal of Hartmann's procedure. The procedure proceeded smoothly and was deemed satisfactory.

Conclusions: The technique of lifting and fixing the rectal stump to the abdominal wall is useful in cases where dense pelvic adhesions are anticipated during the subsequent reversal of Hartmann's procedure.

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背景：由于盆腔炎症导致的致密粘连，哈特曼逆转手术非常复杂。这些粘连给识别直肠带来了挑战，并增加了盆腔器官损伤的风险：方法：我们提出了一种将直肠残端抬起并固定在腹壁上的技术，以减少直肠粘连，便于识别直肠残端：患者因乙状结肠穿孔导致全身腹膜炎而接受了哈特曼手术。腹腔被粪便腹水严重污染，预计术后会出现盆腔粘连。因此，直肠残端被抬起。结果表明，尽管腹腔内存在致密粘连，但在哈特曼手术逆转过程中，直肠段被及时发现。手术进行顺利，结果令人满意：将直肠残端上提并固定在腹壁上的技术对于在随后的哈特曼逆转术中预计会出现致密盆腔粘连的病例非常有用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Techniques in Coloproctology GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.30

自引率

9.10%

发文量

176

审稿时长

1 months

期刊介绍： Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.