ArticleSurgical endoscopy2026
Robotic Hartmann reversal is associated with reduced postoperative complications compared with laparoscopic approach: a propensity-weighted NSQIP study.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHartmann reversal is associated with significant postoperative morbidity and mortality. Studies have showed that a minimally invasive approach to a Hartmann reversal has increased in frequency in the past several years. We aim to compare postoperative complications for robotic versus laparoscopic Hartmann reversal.
methodsWe used the 2022-2023 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to identify patients ≥ 18 years old who underwent a minimally invasive Hartmann reversal procedure. We used propensity score weighting and a multivariable regression model to assess association between postoperative outcomes in the robotic versus laparoscopic groups. The primary outcome was defined as a composite of postoperative complications including stroke, myocardial infarction, wound infection, respiratory and renal failure. Secondary outcomes included unplanned conversion to open, return to the operating room, operative duration, and total length of stay.
resultsOf 4778 patients, 1102 (23%) underwent a robotic procedure, while 3676 (77%) underwent a laparoscopic procedure. Those who underwent a laparoscopic surgery had 24% higher odds of postoperative complications compared to robotic surgery (OR 1.24(1.01-1.53), p = 0.042). The laparoscopic group had 20% longer length of stay (5.1 vs 4.3 days, OR 1.20(1.13-1.27), p < 0.001). Operative time was longer for the robotic approach, with a mean operation time 14% higher than with the laparoscopic approach (216 vs 252 min, OR 0.86 (0.84-0.89), p < 0.001). The laparoscopic group had lower rates of return to OR within 30 days (4.2% vs 5.7%, OR 0.73(0.54-0.99), p = 0.042). Robotic Hartmann reversal was associated with a lower rate of 30-day postoperative complications compared to the laparoscopic approach.
conclusionThese findings support the increasing adoption of robotic Hartmann reversal, demonstrating lower postoperative morbidity compared with laparoscopy despite longer operative times.
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