Die laparoskopische Wiederanschlussoperation nach Hartmann-Resektion

Zusammenfassung

Zwischen dem 1.1.2003 und dem 30.6.2009 wurden 923 komplexe laparoskopische kolorektale Eingriffe von einem Chirurgen vorgenommen und prospektiv anhand einer Datenbank mit 152 Variablen erfasst. Bei 15 Patienten (10 Frauen, 5 Männer) mit einem medianen Alter von 61 Jahren (Spanne: 35–83 Jahre) erfolgte laparoskopisch eine Wieder­anschlussoperation. Bei 3 Patienten war dem Eingriff eine konventionelle Sigma-Diskontinuitäts­resektion, in 12 Fällen eine laparoskopische Kolonresektion mit Hartmann-Situation vorausgegangen. Eine Konversion war in keinem Fall notwendig, die mediane Operationsdauer betrug 100 min. Sowohl intra- als auch postoperativ sahen wir bis auf einen Wundinfekt (6,6 %) keine Komplikationen. Die mediane postoperative Verweildauer betrug 8 Tage. Die laparoskopische Wiederanschlussoperation stellt einen anspruchsvollen Eingriff dar, der für den Geübten technisch ­sicher und gut mit einer geringen Morbidität und Mortalität machbar ist. Die bekannten Vorteile der laparoskopischen Kolon­chirurgie scheinen auf die laparoskopische Wiederanschlussopera­tion übertragbar zu sein. 

Abstract

In the period from January 2003 to June 2009 923 complex laparoscopic colorectal procedures were performed by one surgeon. Data was as­sessed prospectively in a database including 152 variables. In 15 patients (10 f, 5 m), with a median age of 61 years (range: 35–83 years), discontinuity resection of the colon was performed including 3 patients with open discontinuity resection of the sigma and 12 patients with laparoscopic Hartmann procedures. In all cases continuity of the ­colon was recovered laparoscopically. Median op­er­ation time was 100 min, conversion to an open procedure was not necessary. No intra-operative complications occurred and only one wound infection (6.6 %) was recorded postoperatively with a median postoperative stay of 8 days. Although the laparoscopic approach to recover continuity of the colon is technically challenging, we con­clude that the experienced bowel surgeon is able to perform the laparoscopic approach with a low morbidity and mortality by retaining the well known advantages of laparoscopic colonic sur­gery. 

Schlüsselwörter

laparoskopische ­Wiederanschlussoperation - Morbidität - Mortalität - Literaturübersicht

Key words

laparoscopic Hartmann ­reversal - morbidity - mortality - literature analysis

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