Laparoscopic, robotic and transanal reversal of Hartmanns: pitfalls and challenges

The Hartmann procedure is the gold standard surgical intervention for a variety of emergencies, it comprises of a sigmoid colectomy and formation of an end colostomy followed by closure of the rectal stump within the pelvis. Reversal of Hartmann’s remains a complex procedure and restoration of intestinal continuity occurs in a significantly low percentage of patients leading to a negative impact on their quality of life. With the advent of minimally invasive colorectal surgery, there is increasing evidence that a combined laparoscopic, robotic and transanal approach to reversal of Hartmanns seems to be a safe and feasible technique. Our aim was to outline the common pitfalls and difficulties, describe a combined laparoscopic, robotic and transanal approach and suggest operative techniques in particularly difficult reversals.