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What is laparoscopic Hartmann procedure reversal?
The laparoscopic Hartmann procedure reversal is done to close the colostomy (large bowel opening onto the skin) that was previously done. This is followed by reconnecting the two parts of the intestine that were previously separated.
Laparoscopic Hartman procedure: It is an operation in which part of the large bowel (the sigmoid colon) is removed due to recurrent disease or cancer. At that time of the surgery, it was not possible to re-join the bowel, so the rectum or anus was sealed off. The upper part of the large bowel was brought out to the skin as an opening of the bowel. This procedure is known as a colostomy.
Laparoscopic Hartmann reversal: In this procedure, a surgeon will restore the normal structure of the large bowel so that the patient may pass the fecal matter via the anus. The colostomy wound will be closed with stitches. The surgery aims to restore the continuity of the bowel. For most patients, this may improve their bowel function/quality of life because they will no longer have a colostomy and the need to wear a stoma bag.
How is Hartmann procedure reversal performed?
Hartmann reversal procedure is major surgery and can take about 180 minutes for the surgeon to complete the procedure. Laparoscopic Hartmann procedure reversal is a challenging operation.
- It is usually done under spinal or general anesthesia. The patient may be monitored throughout the procedure.
- This operation can be performed in one of two ways, either by laparoscopic method (keyhole surgery) or laparotomy (open procedure).
- A laparotomy involves making a large cut in the abdominal wall that allows the surgeon to operate on the bowel or intestine.
- Laparoscopic surgery is completed using a system of scopes inserted through three or four much smaller cuts in the abdomen. The laparoscopic approach offers significant advantages over the open approach in terms of decreased complications (e.g., surgical site infection) and reduces the duration of postoperative hospitalization. It requires a shorter operating time and can achieve more rapid normal bowel function.
- The surgeon may re-join the bowel either using special stapling instruments or sutures (stitches). This will restore the normal function of the large bowel.
- The colostomy hole is closed and sealed off and the patient’s stoma bag is usually removed during the procedure.
How much time interval is usually required between a Hartmann procedure and a Hartmann reversal?
The interval between the primary Hartmann procedure and subsequent Hartmann procedure reversal should be considered depending on the patient’s recovery. For optimal outcomes, the reversal should be performed at least 6 months after the primary procedure is performed.
What are the risks involved in the Hartmann reversal procedure?
Surgery to re-join the bowel is a challenging operation and there are some risks associated with it. Undertaking this surgery does not guarantee that the stoma will actually be reversed.
- Anastomotic leak or leak from the re-join of the bowel: In a small number of patients, 4%, the area where the bowel has been stitched together can leak. This can be a serious complication and sometimes an operation is needed to reform a stoma. However, if the leak is small, resting the bowel by not drinking or eating may be enough for the area where the bowel was joined together to heal.
- Ileus (paralysis of the bowel) and small bowel obstruction: Sometimes, the bowel is slow to start working again after surgery (ileus). If this happens, the bowel may need to be rested and a drip (a tube into a vein in the arm) is used to replace fluids. In addition, the patient may need a nasogastric tube (tube in the nose that passes into the stomach), which in most cases will prevent vomiting. These will remain in place until the bowel recovers. Sometimes, if the bowel is obstructed, an operation may be required.
- Infection: Infection at the site of operation or nearby areas like the chest is one of the risks of this procedure.
- Bleeding and blood clots are other complications that may arise after or during the procedure.
- Risk of life: Reversal of Hartmann procedure is classified as major surgery. It can carry a risk to the patient’s life. Most people will not experience any serious complications from their surgery. However, risks do increase with age and for those with heart conditions and diabetes.
How soon can a patient recover after the Hartmann reversal procedure?
Most people make a good recovery. It is usual for the bowel to stop working for a few days. The patient may be able to go home after five to ten days. It can take up to three to four months to return to normal activities. The patient may be on painkillers and antibiotics for a few weeks.
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