1. 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 2003. 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 199612162 8 Delgado et al 199811144 7 Kohler et al 199919114117.5 15.8 Vacher et al 200238 15102.63157923.5 Rosen et al 20052215894.2 14 Khaikin et al 20062722814.86 33 Faure et al 200714 vs 20143 vs 18014.39.5 vs 11 14 vs 30 Slawik et al 20082880737 11 Carus et al 2008286917.98.6 14.3 Haughn et al 200861 vs 61154 vs 200 3.3 vs 16.416.4 vs 16.413.1 vs 3.3 Chouillard et al 200944 vs 44195 vs 1609.14.8 vs 6.82.2 vs 0 11.4 vs 28.6 Mazeh et al 200941 vs 41193 vs 20919.56.4 vs 8 4.8 vs 12.1 Achkasov et al 201036 vs 35179vs 2660 9.1 vs12.9 5.9 vs 9.1 Svenningsen et al 201021 vs 22285 vs 15854 vs 6 10 vs 14 Leroy et al 2011421179.57 19.04762 Hai et al 2011281660 10.7 Summary of literature Papers comparing laparoscopic to open reversals highlighted Significant differences in red