LAPAROSCOPIC-ASSISTED COLOSTOMY CLOSURE AFTER HARTMANNS PROCEDURE

PURPOSE: The aim of the study was to review our experience with colost omy closure after Hartmann's procedure and the possible impact of lapa roscopic colostomy closure. METHODS: A retrospective review of hospita l stay after colostomy closure by laparotomy in the last four years wa s conducted. A chart review of patients undergoing laparoscopic colost omy closure after Hartmann's procedure since the introduction of opera tive laparoscopy at our institution was also done. RESULTS: One hundre d twenty patients had colostomy closure carried out by the trauma serv ice at the University of Miami/Jackson Memorial Hospital. In thirty-se ven patients, colostomy closure was associated with other surgical pro cedures such as ventral herniorrhaphy, delayed closure of the open abd omen, ureteroneocystostomy, and so forth, or they underwent loop colos tomy closure. These patients were excluded from further review. Sixty- five patients underwent reversal of Hartmann's procedure by laparotomy . They had an average hospital stay of 9.5 days (range, 6 to 34 days). This group of patients had colostomy closure prior to the introductio n of operative laparoscopy in our institution. With increased laparosc opy experience, laparoscopically assisted Hartmann's reversal has been attempted in 18 patients and completed in 14 patients. The average ho spital stay in the laparoscopically completed group was 6.3 days (rang e, 4 to 10 days). This group had a 0 percent mortality and a 14.3 perc ent morbidity. This compares favorably to recently reported series of colostomy closure by laparotomy. CONCLUSION: Laparoscopically assisted Hartmann's reversal results in comparable morbidity, but may be assoc iated with shorter hospital stay, when compared with laparotomy.