VM68 - Useful Tips for Hartmann's Reversal

ONGOING VIDEOS

Location: ASCRS Connect Lounge, Hall B1/B2, Ground Level

Video Presentation(s)

Slawomir Marecik, MD, FACS, FASCRS

Clinical Professor of Surgery, UIC
Advocate Lutheran General Hospital
Park Ridge, IL, United States

All of the relevant financial relationships listed below have been mitigated.
Medtronic: Consultant (Ongoing)

Author(s)

Devesh S. Ballal, MD

Fellow
Advocate Lutheran General Hospital, Park Ridge, IL
Advocate Lutheran General Hospital, Park Ridge, Illinois
Park Ridge, Illinois, United States

Disclosure information not submitted.
AD

Analine Delgado, BS

Student
Advocate Lutheran General Hospital, Park Ridge, IL
Park Ridge, Illinois, United States

Disclosure information not submitted.
KK

Kunal Kochar, MD, FACS, FASCRS

Assistant Professor of Clinical Surgery, UIC
Advocate Lutheran General Hospital, Park Ridge, IL
Park Ridge, Illinois, United States

Disclosure information not submitted.
John J. Park, MD, FACS, FASCRS

Clinical Professor of Surgery, UIC
Advocate Lutheran General Hospital, Park Ridge, IL
University of Illinois College of Medicine
Lake Forest, Illinois, United States

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Slawomir Marecik, MD, FACS, FASCRS: Medtronic: Consultant (Ongoing)

Image or Table (Do Not add text here):

Purpose/Background: Hartmann's colostomy reversal is a challenging procedure, even for colorectal surgeons. Obesity adds a significant difficulty level.
The reasons why the procedure is challenging are:
•Rectal stump can be shrunken, narrowed & retracted
•Rectal stump can be too long (retained sigmoid & rectosigmoid), making the passage of EEA stapler complex (trauma, bowel wall splitting)
•Diversion proctitis
•The existing TA staple line can be defective or ischemic
•Inadvertent incorporation of tics/valves into anastomosis on the rectal stump & proximal colon sides
•Difficult identification of actual upper rectum for anastomosis

Methods/Interventions: Our patient was a male with a BMI of 48, a large pannus, and a stricture of the colostomy. We described the preop rectal stump preparation techniques and emphasized the importance of intraop flexible sigmoidoscopy.
We described two crucial anatomical landmarks, identifying the level of the upper rectum, underneath which the future anastomosis should be safely created (these are the rectosigmoid kink and anterior fat pad of the upper rectum).
For obese patients, we recommended considering using the Lone Star retracting system for the ostomy dissection.
An effective utilization of the robotic surgical system was described.
Intraoperatively, we suggest never trusting the old TA staple line and always considering revising it.
In addition, we described how to buttress the anastomosis with the surrounding well-vascularized tissues.

Results/Outcomes: Our patient's surgery was uneventful despite intraoperative surprises and difficulties.

Conclusion/Discussion: Hartmann's reversal procedure can be safely performed on the most challenging patients. Many tips and tricks can be used to achieve a successful outcome.