Laparoscopic vs open reversal of Hartmann’s in unselected patients – a teaching centre experience over 8 years including long-term follow-up Nottingham University Hospitals, Queens Medical Centre R K Maitra, C Maxwell-Armstrong, T Pinkney, J Smith, C Gornall, J H Scholefield, J P Williams, M H Robinson, J F Abercrombie, N C Armitage, A G Acheson Introduction: Reversal of Hartmann’s has a high reported morbidity and mortality (5% and 50% respectively). Laparoscopic reversal of Hartmann’s was first described in 1996 with a number of studies showing reduced short-term morbidity and hospital stay compared to open procedures. Our series is one of the largest comparing open to laparoscopic reversal of Hartmann’s. Methods: All laparoscopic cases were maintained on a prospective database from We identified all open reversals from the same period. Retrospective review of all patients was performed including long-term outcomes and follow up. All patients presenting to 2 consultants had attempted laparoscopic reversals – this constituted 85% (n=35) of the laparoscopic patients. Patients divided into 3 groups – laparoscopically completed procedures (‘laparoscopic’ group), laparoscopic procedures converted to open (‘converted’ group), open procedures (‘open’ group). Conversion rate 31% No significant differences in age or sex between the three groups. More patients in the converted group had previous peritonitis but this was not statistically significant. Significantly increased risk of conversion with previous peritonitis (p=0.034) Short-term outcomes No significant difference in operating times (p=0.658) Significantly lower post-operative morbidity in laparoscopic group (0.036) Higher rate of 30-day return to theatre, not significant (p>0.05) Significantly shorter hospital stay in laparoscopic group (p<0.001) Significantly lower anastomotic leak No correlation between operating times and BMI in laparoscopic patients (r=0.146, p=0.41) No correlation between surgeon experience and operating times in laparoscopic patients (r=-0.26, p=0.147) Long-term outcomes No significant difference in re-admission rates (p<0.05) Significantly lower re-operation rates in laparoscopic compared to open groups (p=0.009) Significantly lower rate of stoma-site herniae between laparoscopic and open groups (p=0.001) Total 74 Laparoscopic 28 Converted 13 Open 33 4-month follow-up Discharged 14 (18%) Laparoscopic 7 (25%) Converted 2 (15%) Open 5 (15%) Missing 8 (10%) Laparoscopic 4 (14%) Converted 1 (7%) Open 3 (9%) 12-month follow-up Discharged 27 (36%) Laparoscopic 10 (35%) Converted 5 (38%) Open 12 (36%) >12-month follow-up 25 (33%) Laparoscopic 7 (28%) Converted 5 (38%) Open 13 (39%) Conclusions: Laparoscopic reversal has a high conversion rate in unselected patients Risk of conversion is significantly higher in patients with previous peritonitis Laparoscopically completed reversals have better outcomes Reduced 30-day morbidity Shorter post-operative hospital stay Reduced rate of re-operations (small difference) Fewer stoma-site heraniae year Number of patients (Lap vs open) operation duration (mins) (Lap vs Open) Conversion rate (%) Hospital stay (days) (Lap vs Open) Mortality (%) (Lap vs Open) Total morbidity (%) (Lap vs Open) Re- admissions (%) (Lap vs Open) Re- operation (%) (Lap vs Open) Macpherson et al Delgado et al Kohler et al Vacher et al Rosen et al Khaikin et al Faure et al vs vs vs vs 30 Slawik et al Carus et al Haughn et al vs vs vs vs vs 3.3 Chouillard et al vs vs vs vs vs 28.6 Mazeh et al vs vs vs vs 12.1 Achkasov et al vs 35179vs vs vs 9.1 Svenningsen et al vs vs vs 6 10 vs 14 Leroy et al Hai et al Summary of literature Papers comparing laparoscopic to open reversals highlighted Significant differences in red