Open vs laparoscopic approach for reversal of Hartmann's procedure: a systematic review

Aim A meta-analysis of published literature comparing open vs laparoscopic Hartmann's reversal. Method MEDLINE, EMBASE, CINAHL, PubMed and the Cochrane databases were searched from January 1993 to August 2008. The bibliography of selected trials was scrutinized and relevant references obtained. A systematic review was performed to obtain a summative outcome. Results Eight comparative studies involving 450 patients were analysed. One hundred and ninety-three patients were in the laparoscopic and 257 in the open group. Laparoscopic reversal has a significantly reduced complication rate (z = -2.92, P < 0.01), intra-operative blood loss (z = -7.34, P < 0.001) and hospital stay (z = -3.16, P < 0.01) compared with the conventional approach. No difference in leak rates was found. Conclusion Laparoscopic reversal of Hartmann's procedure is safe, has fewer complications and shorter hospital stays. This approach may be considered for reversal, however, randomized controlled trials are required to strengthen the evidence.