A Hartmann procedure is when part of the lower end of the colon, sigmoid colon, and/or part of the rectum is removed and a colostomyis put in place as a form of bowel diversion. If the rectum is left in place, it is stapled shut or closed off and left inside the body. This procedure may be reversed at some later point in time, although nearly two thirds of the time it is left as a permanent fixture for the patient.
Hartmann’s procedure has been around since the early 1920’s and is named after Dr. Henri Albert Hartmann, who first proposed this type of surgery to deal with obstructive cancer of the lower end of the colon. At the time, using this new procedure decreased mortality rates in patients by nearly 30% over previous methods. Over the years, the procedure has been refined.
Today it is mostly used in emergency cases where a blockage is causing severe problems. Instances of diverticulitis resulting in a perforation or a tumor that may be possibly cancerous are among the leading reasons this type of operation may be performed. It may also be performed if the patient is not a suitable candidate for more preferred types of colon surgery due to certain health conditions.
The risks for this type of operation are similar to most other kinds of surgery. Bleeding or infection at the resection site being the most common setback. Colon adhesions and blockages may also occur. This type of operation is also close to the bladder and nerves involved in sexual function. There is risk that something in this area may be damaged. Sexual problems for men that arise are usually a temporary problem and normal function usually returns over a period of time. Ileus, or paralysis of the bowel, is another possible risk. Any potential problems a patient may be having should be reported to the surgeon or ostomy nurse.
Depending on the type of surgery that was performed, laparoscopic or open, recovery time in the hospital can last anywhere from 5 to 10 days. Laparoscopic surgery typically requires less time as it is a less invasive type of operation.
Eating and drinking are encouraged as soon as the patient feels up to it, as is getting up and walking. Walking helps reduce the risk of blood clots or infection occuring in the lungs.
After the condition which lead to having the surgery being done in the first place has been given enough time to heal, reversal of the Hartmann’s procedure may performed if applicable. Follow up visits with the surgeon to check the progress of healing may lead to a recommendation of a reversal.