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Hartmann’s Reversal by a Combined Transanal-Transabdominal Approach

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Transanal Minimally Invasive Surgery (TAMIS) and Transanal Total Mesorectal Excision (taTME)

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Abstract

Hartmann’s reversal allows for restoration of bowel continuity, continence, and improved quality of life. However, colostomy closure is still discouraged in a substantial number of patients, mostly due to its risk of morbidity and even mortality. It is considered a technically challenging procedure, mainly when the index Hartmann’s operation was performed in the setting of an emergent situation.

Minimally invasive surgery has proven benefits but also several limitations derived from working in the fixed bony space with straight laparoscopic instruments. In cases of obese patients, with frozen pelvises or with fibrotic short stumps, the situation may become even more complicated, and the outcomes of centers of expertise may be difficult to extrapolate. To overcome some of these factors, the transanal approach was developed. It is a derivative of the same approach developed for rectal cancer (taTME), which conserves its advantages. Specifically, the transanal approach for Hartmann’s reversal may help in localizing the rectal stump, working through virgin anatomic planes, and – with better visualization – it allows for construction of an anastomosis in healthier tissue. This chapter aims to describe the application of the taTME approach toward Hartmann’s reversal, although readers should appreciate that this procedure is still in its infancy.

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Authors and Affiliations

  1. Maisonneuve-Rosemont Hospital, General Surgery Department, Montréal, Québec, Canada

    Jean-Sébastien Trépanier

  2. Gastrointestinal Surgery Department, Hospital Clinic, University of Barcelona, Barcelona, Spain

    F. Borja de Lacy & Antonio M. Lacy

Authors
  1. Jean-Sébastien Trépanier
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  2. F. Borja de Lacy
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  3. Antonio M. Lacy
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Corresponding author

Correspondence to Jean-Sébastien Trépanier .

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Editors and Affiliations

  1. AdventHealth Orlando, Oviedo Medical Center, and University of Central Florida College of Medicine, Orlando, FL, USA

    Sam Atallah

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Trépanier, JS., de Lacy, F.B., Lacy, A.M. (2019). Hartmann’s Reversal by a Combined Transanal-Transabdominal Approach. In: Atallah, S. (eds) Transanal Minimally Invasive Surgery (TAMIS) and Transanal Total Mesorectal Excision (taTME). Springer, Cham. https://doi.org/10.1007/978-3-030-11572-2_42

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  • DOI: https://doi.org/10.1007/978-3-030-11572-2_42

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-11571-5

  • Online ISBN: 978-3-030-11572-2

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