Our Summary

The Hartmann procedure is a type of surgery often used in emergencies to treat diseases affecting the left side of the large intestine. It was originally designed for treating colorectal cancer and involves removing part of the intestine (sigmoidectomy) and creating an opening in the abdomen for waste to pass through (stoma), without reconnecting the remaining parts of the intestine. This procedure carries a high risk, with death rates around 15% and complications in about 50% of cases. In less than half of the patients, doctors are able to restore the normal passage of waste inside the body at a later stage. This paper reviewed the effectiveness of the Hartmann procedure for different conditions including colorectal cancer, inflammation of the abdomen from a ruptured diverticulum (diverticular disease), complications after joining two ends of intestine (anastomotic complications), reduced blood supply to the colon (ischemic colitis), twisting of the left side of the colon (volvulus) and abdominal injuries.

FAQs

  1. What is the Hartmann procedure and when is it typically used?
  2. What are the risks associated with the Hartmann procedure?
  3. What is the restoration of intestinal continuity and how often is it successfully achieved after the Hartmann procedure?

Doctor’s Tip

One helpful tip a doctor might tell a patient about sigmoidectomy is to follow post-operative care instructions closely, including taking prescribed medications, avoiding heavy lifting, and maintaining a healthy diet to promote healing and prevent complications. It is also important to attend follow-up appointments with your doctor to monitor your recovery progress and address any concerns or issues that may arise.

Suitable For

Patients who are typically recommended sigmoidectomy include those with left-sided colonic disease, such as colorectal cancer, peritonitis from diverticular disease, anastomotic complications, ischemic colitis, left-sided colonic volvulus, and abdominal trauma. The Hartmann procedure is often used in emergency situations where intraoperative conditions do not allow for completion of an anastomosis. This procedure involves sigmoïdectomy without restoration of intestinal continuity, resulting in a left-sided iliac terminal stoma and closure of the rectal stump. However, the Hartmann procedure is associated with high rates of mortality and morbidity, as well as a low rate of subsequent restoration of internal continuity.

Timeline

Timeline of patient experience before and after sigmoidectomy:

Before sigmoidectomy:

  1. Diagnosis of left-sided colonic disease, such as colorectal cancer, diverticular disease, anastomotic complications, ischemic colitis, left-sided colonic volvulus, or abdominal trauma.
  2. Evaluation of the need for surgery and determination that a sigmoidectomy is necessary.
  3. Pre-operative preparation, including medical tests, consultations, and bowel preparation.
  4. Admission to the hospital for surgery.

During sigmoidectomy:

  1. Surgical procedure to remove the sigmoid colon.
  2. Creation of a left-sided iliac terminal stoma and closure of the rectal stump.
  3. Recovery in the hospital post-surgery.

After sigmoidectomy:

  1. Recovery period in the hospital, which may include pain management, monitoring for complications, and physical therapy.
  2. Adjustment to life with a stoma, including learning how to care for it and manage any related issues.
  3. Follow-up appointments with the surgeon to monitor healing and discuss potential restoration of intestinal continuity.
  4. Potential subsequent surgeries to restore internal continuity, depending on the patient’s condition and risk factors.
  5. Long-term follow-up to monitor for recurrence of disease and overall health.

What to Ask Your Doctor

  1. What is the reason for recommending a sigmoidectomy and Hartmann procedure in my case?
  2. What are the potential risks and complications associated with this procedure?
  3. What is the expected recovery time and post-operative care plan?
  4. Will I need a temporary stoma after the surgery and, if so, for how long?
  5. What are the chances of needing a second surgery to restore intestinal continuity in the future?
  6. Are there any alternative treatment options available for my condition?
  7. How will this procedure affect my quality of life in the long term?
  8. What are the long-term implications of having a rectal stump after the Hartmann procedure?
  9. What is the success rate of the Hartmann procedure in treating colorectal cancer or other conditions?
  10. Are there any specific dietary or lifestyle changes I should make before or after the surgery?

Reference

Authors: Barbieux J, Plumereau F, Hamy A. Journal: J Visc Surg. 2016 Feb;153(1):31-8. doi: 10.1016/j.jviscsurg.2016.01.002. Epub 2016 Feb 8. PMID: 26868514