We present the operative technique and the results of the laparoscopic approach for Hartmann's colostomy reversal. Thirty two patients were prospectively analysed from december 1991 to june 1997. They presented a similar incidence regarding sex distribution, and a median age of 42.4 years old. Ali patients underwent the same preoperative preparation and operative technique. Three (9.3%) intraoperative complications were observed: an uncompleted anastomosis (3.1%), requiring an endosuture, a rectal perforation by the mechanical stapler and a right epigastric artery lesion. There were convertion to open surgery in three (9.3%) patients: one (3.1%) due to rectal perforation by the mechanical staple1; one (3.1%) for tumoral pelvic invasion and another because of excessive intra-peritoneal adhesions. Operative time varied from 30 to 240 minutes, with a mean time of 126;2 minutes. Nine (31.0%) patients didn't present pain, while 13 (44.8%) referred minimal pain and seven (24.0%) complained severe pain. Oral liquid diet intake occurred within a mean time of 1.6 days and the first evacuation observed after a mean 3.2 postoperative days. Mean hospitalization time was 4.7 days. Postoperative complications occurred in eight (27.5%) patients. Two (6.8%) stoma wound infections, right shoulder pain in two (6.8%) patients, one (3.4%) anastomotic dehiscence, one peritonitis probably due to contaminationfrom surgical instruments, a liquid pelvic coliection and an incisional haernia. 1n conclusion, videolaparoscopic restoration of the intestinal transit demonstrated to be safe and effective. It could be the method of choice because of its success in 90.6 per cent of the patients.
Laparoscopy; Operative technique; Colono