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Laparoscopic stoma reversal
This patient was operated upon a couple of months before because of a complicated diverticulitis. Hartmanns procedure was performed, meaning the removal of the inflamed portion of the sigmoid colon, closing of the rectal stump and deviating the proximal colon as a stoma in the left abdominal wall. Now the time has come to restore the continuity of the colon and remove the stoma.
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In the x-ray the rectal stump can be seen as well as the stoma in the left lower abdomen (right on the x-ray). In 2 the stoma can be seen just after removal of the containerbag.
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The patient is covered with sterile drapes and then the skin is incised and the stoma closed with sutures. It is freed from the abdominal wall (3-7). The last part of the stomal part is cut and the anvil of a special device is put in the colon that is tied around it. Then the colon is placed in the abdomen (7,8). The anvil will later be connected to the other part of the device that is entered in the rectal stump.
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Then a check is made for adhesions in the abdomen as far as possible. Working channels are introduced for the optical system and instruments. The laparoscopic part of the operation is now being performed with adhesiolysis and freeing of the rectal stump and making sure there is enough length for a tensionfree anastomosis (new connection, 9-12).
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With a special instrument the rectal stump is prepared for the special device (13-15). The anvil in picture 8 is then connected with the device of 15, which is secured and fired. A check for leakage is made: water is poored around the anastomosis and then air is injected through the anus. If no airbubbles appear, there is no leakage (16-19).
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