EP124 - A Retrospective Analysis of Early Reversal after Laparoscopic Hartmanns procedure for Patient undergoing Elective surgery with Poorly Prepared Bowel.

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Purpose/Background: Patient undergoing elective laparoscopic anterior resection for colorectal cancer (CRC) are given bowel preparation as a part of preoperative protocol. However in patients with bulky or stricturous growth on preoperative staging, bowel preparation is avoided owing to the risk of perforation. Similarly, certain patients have intraoperative fecal loaded and edematous bowel owing to poor bowel preparation. Such patient are at a high risk of anastomotic leak. Covering ileostomy in these cases do not decrease incidence of leak. Hartmanns procedure with reversal at 3- 6 months is an alternative. However, the morbidity with such a late reversal is high owing to technical difficulties and most such patients end up having a permanent stoma. We present a safer alternative for such cases – which involves laparoscopic Hartmann creation in the index procedure followed by early reversal within 7 days after bowel preparation.

Methods/Interventions: We performed a retrospective analysis on the patients planned electively for laparoscopic anterior resection for CRC at our institute between January 2024 and October 2024. These patients had pre-operative staging suggestive of large bulky tumor precluding bowel preparation or intra-operatively had fecal loaded bowel or edematous bowel. All the patients who underwent early laproscopic hartmanns reversal which we define as reversal in less than 7 days of hartmanns creation in the index procedure were recruited. All these patients were given mechanical bowel preparation along with oral antibiotics before reversal of Hartmann.

Results/Outcomes: We retrospectively studied early Hartmans reversal in 8 patients with CRC. Median Age was 51 years [Interquartile range (IQR) 37-73 years]. 87.5% (n=7) and 12.5% (n=1) had upper third rectal/sigmoid and mid rectal primary respectively. Scope was not negotiable in 87.5% (n=7) patients. Clinically, T3/T4 tumor was found in 87.5% (n=7) patients. 37.5% (n=3) patients had ASA score of ≥ 3. Time for Hartmans reversal was < 3 days in 25% (n=2), 3-7 days in 75% (n=6). Median operative time for reversal procedure was 130 minutes (range 120-160 minutes). Median blood loss was 50 ml (range 50-350 ml). Covering ileostomy was done in 50% (n=4) patients. 25% (n=2) patients had Clavien-Dindo ≥ grade III complications. Both the patients had perioperative cardiac complications. Superficial port site dehiscence was reported in one patient. None of the patients developed post-operative leak. Median duration of hospital stay was 11 days (range 6-8 days). No mortality was reported within 30 days of surgery.

Conclusion/Discussion: Our data suggests that early laparoscopic hartmanns reversal which we define as reversal less than 7 days of index procedure is a safe technique with low rates of anastomotic leaks. Reversal is technically feasible and has minimal postoperative morbidity, and decreases the incidence of permanent stoma creation. This findings will require to be evaluated in further larger studies.