LAPAROSCOPIC SIGMOIDOSTOMY TECHNIQUE FOR REESTABLISHMENT OF BOWEL CONTINUITY USING THE HARTMANN PROCEDURE

Reestablishing bowel continuity subsequent to sigma resection with ter minal descendostomy and blind closure of the rectum (Hartmann procedur e) by a descendo-rectostomy (DR) is well suited for a laparoscopic app roach. One part of the operation is performed extracorporally, and wit h the laparoscopic operation there is no need to consider radical tumo r surgery or staging rules. We demonstrate our techniques for laparosc opic DR. - Operational steps. - A. conventionally: complete dissection of the descendo-stoma, insertion of a 29 or 31 mm circular stapler he ad secured by a purse string suture and repositioning of the colon int o the abdomen; blunt dissection of reachable intra-abdominal adhesions with a finger, and placement of a 10-mm umbilical trocar using palpat ion; air tight closure of the abdominal wall at the original stoma sit e. B. laparoscopically: upon creation of a CO2 pneumoperitoneum, place ment of two additional 10 mm trocars; adhesiolysis of the pelvis; prep aration of the blind rectal stump; transanal insertion of the circular stapler and perforation of the rectal stump; bringing down the proxim al colon into the pelvis (possible need to mobilise the splenic flexur e); reconnecting the stapler head with the instrument and firing the s tapled anastomosis. - The postoperative period was uneventful. Using a laparascopic approach for a DR following Hartmann's procedure is an a ttractive and viable method to reestablish bowel continuity.