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We report herein our surgical experience of Hartmann's procedure reversal using laparoscopic technique in a 72-year-old woman who underwent Hartmann's procedure for an obstructing sigmoid colon cancer 6 month earlier. The purposes of this report are to describe our technique of laparoscopic reversal of Hartmann's procedure, to introduce several technical tips in avoiding pitfalls, and to review its safty and efficacy. In brief, the colostomy was freed from the abdominal wall using a conventional technique, then a center rod and an anvil of a circular stapler were inserted into the colon. CO2 insufflation was performed through this insertion. Using a five-cannula technique, rectal stump was mobilized, then colorectal anastomosis was performed laparoscopically via a transanal stapled approach. The operating time was 130 minutes and blood loss was 50 ml. There were no intra- and postoperative complications. Up to now, with a 4-month follow-up period, the patient has been well without having any problems associated with this operation
Abdominal Wall ; Aged ; Colon ; Colostomy ; Female ; Follow-Up Studies ; Humans ; Insufflation ; Laparoscopy ; Postoperative Complications ; Sigmoid Neoplasms

10.The Effect of Acute Anemia on The Healing of Intestinal Anastomoses in Rabbits.

Chong Suk KIM ; Gi Bong CHAE ; Bum Hwan KOO

Journal of the Korean Surgical Society 1998;54(4):457-463

In consideration of the potential deleterious effects of blood transfusion, the effect of acute anemia on the healing of both small (SI) and large intestinal (LI) anastomoses was evaluated. Thirty-six white rabbits underwent resection of both the mid-ileum and the distal colon with primary anastomosis of each. One and two weeks post operation, all anastomoses were assessed by anastomotic bursting pressure (ABP) and histologic evaluation utilizing a modified Erhlich/Hunt scale with grading of the WBC influx, blood vessel ingrowth, fibroblast proliferation, and collagen deposition. Results were analyzed using oneway analysis of variance (ANOVA) and the Chi-Square approximation with p<0.05 being considered significant. The SI ABP, reported in mmHg SE, of the anemic rabbits was decreased at one week vs. the controls (234 mmHg 17 vs. 201 mmHg 16), reaching significance at two weeks (190 mmHg 6 vs. 257 mmHg 17). A decreased LI ABP was found at one week, though not quite reaching singnificance (p=0.06). Recovery to control values occurred by two weeks. Histologic assessment (anemia vs. control) demonstrated a uniform decrease in WBC infiltration, reaching significance in the LI group at two weeks. Blood vessel ingrowth was likewise depressed, but did not achieve significance. The collagen contents of both the SI and the LI groups at two weeks decreased, as were the SI fibroblast proliferation at one week (p<0.05). This study demonstrates that severe, acute anemia in rabbits undergoing intestinal anastomoses severely alters histologic parameters in both the SI and the LI anastomoses while decreasing the overall strength of the SI anastomoses.
Anemia* ; Blood Transfusion ; Blood Vessels ; Collagen ; Colon ; Fibroblasts ; Rabbits*

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10.The Effect of Acute Anemia on The Healing of Intestinal Anastomoses in Rabbits.

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