Trans-stomal single-port laparoscopic Hartmann's reversal is an efficacious and efficient procedure: a case-controlled study

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

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.

Hartmann’s Reversal: Controversies of a Challenging Operation

Purpose. Hartmann’s reversal is a complex operation with a high morbidity rate. Minimally invasive surgery has been used to reduce the impact of surgery on fragile patients. The aim of this comparative study is to look at the results of Hartmann’s reversal procedures with different approaches. Methods. All the patients who underwent Hartmann’s reversal were collected retrospectively (124 cases). Sixty-four patients (50.4%) had an open operation, 6 cases (5%) were treated with a conventional laparoscopic approach, 34 patients (28.1%) underwent single incision laparoscopic surgery (SILS), and 20 (16.5%) required other additional trocars. Results. SILS operations were slightly longer than the open procedures (175 min vs 150 min), with the same rate of postoperative complications and reoperations (p = 0.83 and p = 0.42), but with a shorter hospital stay (5 days p = 0.007). Age (p = 0.03), long operative time (p = 0.01), and ASA score (p = 0.05) were identified as independent factors affecting postoperative morbidity. The grade of adhesions caused a longer operative time (p = 0.001) and a higher risk of conversion $\left(p<0.001\right)$ , and short rectal stump increased the risk of protective loop ileostomy (p = 0.008). Patients with grade 2-3 of adhesions had a longer length of stay (p = 0.05). Conclusions. Minimally invasive procedures had a shorter hospital stay and did not show any increase in morbidity rate when compared with open cases. Age, longer operative time, and ASA score increased the risk of postoperative complications. Furthermore, patients with a short rectal stump had a higher chance of having a defunctioning ileostomy.

Efficacy and safety of single port robotic radical prostatectomy and multiport robotic radical prostatectomy: a systematic review and meta-analysis

Background

The purpose of this study is to compare the clinical efficacy and safety of single port (SP) robot radical prostatectomy and multiport (MP) robot radical prostatectomy.

Methods

Using the China National Knowledge database, EMBASE, Cochrane library, PubMed, and other databases to obtain relevant research, SP robot radical prostatectomy and MP robot radical prostatectomy were comprehensively evaluated. The software used to evaluate the impact of the results in the selected articles was Review Manager 5.2. Deviation analysis, forest plot analysis, and sensitivity analysis were carried out for the collected data.

Results

A total of 7 related studies that met the criteria were finally included. The data showed that the operation time of MP in the control group was significantly longer than that in the SP group [mean difference (MD) =−13.29; 95% confidence interval (CI): (−17.35, −9.23); P<0.00001; I²=50%]. The duration of intensive care unit (ICU) stay for SP surgery was shorter than that for MP surgery [MD =−18.30; 95% CI: (−29.17, −7.42); P=0.0010; I²=94%]. The blood loss of SP surgery was less than that of MP surgery [MD =−15.54; 95% CI: (−28.37, −2.71); the total effective rate was 0.02; I²=0%]. There was no significant difference in the incidence of postoperative complications between SP and MP surgery [risk ratio (RR) =0.95; 95% CI: (0.55, 1.63); P=0.85; I²=0%]. At the same time, the sensitivity analysis and funnel plot showed that this study was robust and publication bias was limited.

Discussion

Our results show that SP robotic radical prostatectomy is superior to MP robotic radical prostatectomy in terms of efficacy and safety. SP robot radical prostatectomy is worthy of wide promotion.

Reversal of left-sided colostomy utilizing single-port laparoscopy a multicenter European audit and overview of the literature

Background

Stoma reversal surgery can result in considerable morbidity and even mortality. Feasibility of utilizing single-port laparoscopy through the stoma fenestration have been shown before. Aim of the present observational study is to evaluate multicenter experiences of single-port reversal of left-sided colostomy (SPRLC) throughout Europe and to provide an overview of available literature on this topic.

Methods

All patients undergoing SPRLC in four different teaching hospitals throughout Europe are included. Primary outcome was 30-day postoperative complication rate. Secondary outcomes were postoperative length of stay (LOS), single-port success rate and conversion rates. Appraisal of the available literature in PubMed was performed.

Results

Of 156 SPRLC procedures, 98.7% of them were technically successful and 71.8% were without postoperative complications. No postoperative mortality was encountered. Superficial site infection occurred in 14.7%, anastomotic leakage in 3.9% and major complications in 8.3%. Median LOS was 4.0 days (1–69), single-port success rate was 64.7%, 12.8% and 21.2% (33/154) were converted to an open and multiport laparoscopic procedure, respectively. Literature shows equally favorable results in 131 patients divided over 5 cohorts with morbidity ranging from 0 to 30.4% and mortality from 0 to 2.2% and median LOS of 4–8 days.

Conclusion

This study confirms the safety, feasibility and favorable results of the use of single-port approach in the reversal of left-sided colostomy in different centers in Europe with laparoscopic experienced colorectal surgeons. The available literature on this topic support and show equally favorable results using single-port laparoscopy for left-sided colostomy reversal surgery.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00464-021-08657-x.

Reversal of Hartmann's Procedure: Evaluating Outcomes of Single-Port Laparoscopic Approach Versus Conventional Approach

Bowel restoration following Hartmann's procedure (HP) remains a topic of discussion and innovation. This article seeks to highlight and analyze the outcomes of conventional reversal approaches such as open surgery (OS) and conventional laparoscopic (CL) to single-port laparoscopic reversal (SPLR) approach to evaluate whether SPLR is a feasible alternative to the OS or CL approach. A PubMed search using keywords yielded 5,750 articles. After applying the inclusion/exclusion criteria, 40 articles of relevance were reviewed, and endpoints considered. These included 13 systematic reviews and 27 observational reviews, three of which identified themselves as retrospective or comparative studies. The analysis showed overwhelming support for CL over OS as a choice for HP reversal. Studies comparing SPLR to CL showed SPLR to be a safe and feasible alternative, given its significantly shorter operating times, hospitalization times, and complication rates.