Emergency laparoscopic Hartmann procedure no longer a subspecialist operation: a retrospective cohort study at an Australian non-subspecialized center.

Daniel Cattanach, Peter Tilleard, Jana Bednarz, Bree Stephensen
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Abstract

Purpose: An open Hartmann (OH) procedure generally remains the standard of care for several emergent colorectal conditions. There is a perception that the laparoscopic approach is limited to large subspecialist centers. This study aimed to investigate the outcomes of these emergency procedures in a non-subspecialized regional center.

Methods: We conducted a retrospective cohort analysis on patients who underwent an emergency Hartmann procedure between 2019 and 2023 within a general surgery unit at a regionally located tertiary-level Australian hospital. Patients were classified as having undergone either OH or laparoscopic Hartmann (LH) procedures. Our primary outcome of interest was length of hospital stay (LOS). Secondary outcomes included time to return of gut function, morbidity, and reversal. Differences between the OH and LH groups were assessed descriptively and using confounder-adjusted regression.

Results: We identified 115 patients (83 underwent OH, 32 underwent LH) during the study period. The adjusted estimated mean LOS for patients undergoing an OH procedure was 15.8 days (95% confidence interval [CI], 13.7-17.9) compared to 9.6 days (95% CI, 7.4-11.9) for patients undergoing an LH procedure. The mean time taken for the return of gut function was estimated to be 34% longer following an OH procedure compared to an LH procedure (adjusted incidence rate ratio, 1.34 days; 95% CI, 1.00-1.81). Morbidity was similar between groups. The LH group had higher rates of laparoscopic reversal (91.7% vs. 33.3%).

Conclusion: The expected benefits of laparoscopic surgery may extend to the emergency colorectal setting and LH procedures can be performed safely in a non-subspecialized center.

急诊腹腔镜哈特曼手术不再是亚专科手术:澳大利亚非亚专科中心的回顾性队列研究。
目的:开放的哈特曼(OH)手术通常仍然是一些紧急结肠直肠癌的标准治疗方法。有一种看法认为腹腔镜方法仅限于大型专科中心。本研究的目的是调查这些紧急程序的结果在一个非亚专科区域中心。方法:我们对2019年至2023年在澳大利亚一家区域性三级医院的普通外科部门接受紧急哈特曼手术的患者进行了回顾性队列分析。患者被分类为接受了OH或腹腔镜哈特曼(LH)手术。我们感兴趣的主要结局是住院时间(LOS)。次要结局包括肠功能恢复的时间、发病率和逆转。对OH组和LH组之间的差异进行描述性评估,并使用混杂校正回归。结果:我们在研究期间确定了115例患者(83例OH, 32例LH)。接受OH手术的患者调整后的估计平均LOS为15.8天(95%可信区间[CI], 13.7-17.9),而接受LH手术的患者为9.6天(95% CI, 7.4-11.9)。与LH手术相比,OH手术后肠道功能恢复的平均时间估计要长34%(调整后的发病率比为1.34天;95% ci, 1.00-1.81)。两组间发病率相似。LH组有更高的腹腔镜逆转率(91.7%比33.3%)。结论:腹腔镜手术的预期益处可能扩展到紧急结直肠情况,LH手术可以在非亚专科中心安全地进行。
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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