V97 - Useful Tips for Hartmann's Reversal

Saturday, May 9, 2026

On-Demand

Video Presentation(s)

Slawomir J. Marecik, MD, FACS, FASCRS

Clinical Professor of Surgery, UIC
Advocate Lutheran General Hospital
University of Illinois at Chicago
Park Ridge, IL, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. Intuitive: Consultant (Terminated); Medtronic: Consultant (Ongoing)

Author(s)

Devesh S. Ballal, MD

Fellow
Advocate Lutheran General Hospital, Park Ridge, IL
Advocate Lutheran General Hospital, Park Ridge, Illinois
Park Ridge, Illinois, United States

Disclosure information not submitted.
AD

Analine Delgado, BS

student
Advocate Lutheran General Hospital, Park Ridge, IL
Park Ridge, Illinois, United States

Disclosure information not submitted.
KK

Kunal Kochar, MD, FACS, FASCRS

Assistant Professor of Clinical Surgery, UIC
Advocate Lutheran General Hospital, Park Ridge, IL
Park Ridge, Illinois, United States

Disclosure information not submitted.
John J. Park, MD, FACS, FASCRS

Clinical Professor of Surgery, UIC
Advocate Lutheran General Hospital, Park Ridge, IL
University of Illinois College of Medicine
Park Ridge, Illinois, United States

Disclosure information not submitted.

CME Eligible

Purpose/Background: Hartmann's colostomy reversal is a challenging procedure, even for colorectal surgeons. Obesity adds a significant difficulty level.

The reasons why the procedure is challenging are:

•Rectal stump can be shrunken, narrowed & retracted

•Rectal stump can be too long (retained sigmoid & rectosigmoid), making the passage of the EEA stapler complex (trauma, bowel wall splitting)

•Diversion proctitis

•The existing TA staple line can be defective or ischemic

•Inadvertent incorporation of tics/valves into anastomosis on the rectal stump & proximal colon sides

•Difficult identification of the actual upper rectum for anastomosis

Methods/Interventions: Our patient was a male with a BMI of 48, a large pannus, and a colostomy stricture. We described the preoperative rectal stump preparation techniques and emphasized the importance of intraoperative flexible sigmoidoscopy.

We described two crucial anatomical landmarks, identifying the level of the upper rectum, below which the future anastomosis should be safely created (the rectosigmoid kink and the anterior fat pad of the upper rectum).

For obese patients, we recommended considering using the Lone Star retracting system for the ostomy dissection.

An effective utilization of the robotic surgical system was described. Intraoperatively, we suggest never trusting the old TA staple line and always considering revising it. In addition, we described how to buttress the anastomosis with the surrounding well-vascularized tissues.

Results/Outcomes: Our patient's surgery was uneventful despite intraoperative surprises and difficulties.

Conclusion/Discussion: Hartmann's reversal procedure can be safely performed on the most challenging patients. Many tips and tricks can help achieve a successful outcome.