Hartmann's Procedure

Severe diseases of the colon may be accompanied by inflammation, obstruction, perforation, or other complications that require surgical treatment. In such situations, one of the possible methods is Hartmann's operation.

At «Oxford Medical», operations are performed by experienced surgeons who work with complex cases. Interventions are performed in a modern surgical inpatient department and high-tech operating rooms equipped with expert-class equipment. Whenever possible, minimally invasive techniques are used to reduce tissue trauma and facilitate further recovery.

Hartmann's operation is a surgical intervention during which the affected section of the colon is removed. The end of the bowel that remains on the rectal side is closed, while the other end is brought out through the anterior abdominal wall as a colostomy. After the operation, bowel movements occur through it.

The intervention is most often performed on the sigmoid colon. Such a sigmoid colon resection is necessary when the affected section needs to be removed, but immediately reconnecting the bowel after resection is unsafe.

The colostomy after such a sigmoidectomy may remain permanent or be closed during a repeat operation (the second stage of Hartmann's operation). The surgeon assesses the possibility of restoring the natural route of bowel movements after the patient has recovered, taking into account the reason for the first intervention, the condition of the bowel, and general health.

According to the recommendations of the American Society of Colon and Rectal Surgeons, if obstruction, perforation, or another severe complication occurs during colon cancer treatment, the surgeon chooses the treatment strategy taking into account the patient's condition and the extent of the process. If it is impossible to safely reconnect the bowel after tumor removal, one of the options is Hartmann's resection with the formation of a colostomy.

Doctors at «Oxford Medical» explain: Hartmann's operation is not required for every disease of the sigmoid colon. It is chosen in situations when the affected section needs to be removed, but restoring bowel continuity during the same intervention is associated with a high risk of complications.

There are few absolute contraindications specifically to Hartmann's operation, since it is often performed for severe diseases of the colon and emergency conditions. In such situations, the surgeon assesses not only the diagnosis, but also whether the patient will be able to safely undergo the operation and general anesthesia.

Factors that may limit the possibility of intervention or require preliminary stabilization of the condition include:

• severe decompensated heart or respiratory failure;

• pronounced blood clotting disorders that cannot be quickly corrected;

• severe renal or hepatic failure with decompensation of organ function;

• a terminal condition of the patient in which the risk of major surgical intervention exceeds the possible benefit.

Diabetes mellitus, chronic diseases of the heart and kidneys, and other concomitant diseases are not always in themselves a reason to refuse the operation. Before the intervention, the doctor assesses their severity and the patient's general condition. If the situation allows, the main indicators are stabilized first, and then the operation is performed.

The extent of preparation depends on whether the operation is performed electively or urgently. If the patient's condition allows, examinations are performed before the intervention to assess the extent of the pathological process, the function of vital organs, and possible anesthesia risks.

Depending on the clinical situation, the following may be prescribed:

• general and biochemical blood tests, a coagulogram, and a urine test;

• electrocardiography (ECG);

• CT of the abdominal organs to clarify the location of the lesion, the presence of perforation, inflammation, obstruction, or other complications;

• additional examinations according to indications.

Before a planned operation, the doctor clarifies which medications the patient takes regularly, especially anticoagulants, glucose-lowering agents, and medications for cardiovascular diseases. Their administration regimen is adjusted individually.

Before a planned operation, it is important to follow these rules:

• light food can be consumed no later than 6 hours before anesthesia, fatty food and meat — no later than 8 hours before;

• clear liquids, including water or tea without milk, can usually be consumed no later than 2 hours before anesthesia;

• bowel cleansing with special medications may also be performed.

Doctors at «Oxford Medical» note: our clinic uses the Fast Track Surgery protocol — an approach that helps make preparation for surgery and subsequent recovery less difficult for the patient. It involves avoiding unnecessary restrictions before the intervention, early mobilization after surgery, gradual restoration of nutrition, and other measures that help patients return to their usual routine more quickly.

If the operation is needed urgently, preparation is reduced to the essentials: the main indicators are stabilized, dehydration and electrolyte disturbances are corrected, the necessary tests are performed, and the patient is prepared for anesthesia.

Hartmann's operation is performed under general anesthesia. Depending on the patient's condition, the cause of the disease, and the extent of the pathological process, the intervention is performed laparoscopically or through open access.

With laparoscopic access, a laparoscope with a video camera and special instruments are inserted through several small punctures in the abdominal wall. The image of the surgical area is transmitted to a monitor in an enlarged view. This method makes it possible to reduce tissue trauma and facilitate postoperative recovery.

During open surgery, the surgeon makes an incision in the anterior abdominal wall and gains direct access to the organs of the abdominal cavity. This method may be necessary in cases of extensive inflammation, peritonitis, significant tissue damage, large tumors, or other complex situations. Sometimes during laparoscopy, it becomes necessary to switch to open access.

Regardless of the method, the main stages of the operation are the same:

• the surgeon determines the boundaries of the affected section of the bowel;

• performs resection of the sigmoid colon or another pathologically altered part of the colon;

• closes the end of the bowel on the rectal side and leaves it in the abdominal cavity;

• brings the other end out through the anterior abdominal wall and forms a colostomy;

• if necessary, cleans the abdominal cavity, places drains, and closes the surgical wounds.

After the intervention is completed, the patient is transferred to the postoperative ward or intensive care unit.

After the operation, the patient remains in the hospital until the condition stabilizes and the colostomy begins to function normally. During the first days, the medical staff monitors temperature, blood pressure, the postoperative wound, bowel function, and the stoma.

During the recovery period, it is important to:

• get up and start walking as early as possible, gradually increasing activity (but only after the doctor's permission);

• move every day, but avoid overexertion;

• not lift heavy objects or strain the abdominal muscles for approximately 6 weeks;

• care for the postoperative wound and monitor it for redness, swelling, or discharge;

• regularly empty the colostomy bag and care for the skin around the colostomy;

• take the prescribed medications and attend follow-up examinations.

Nutrition is restored gradually. At first, drinking is allowed, then the patient transitions to light food in small portions 5–6 times a day. During the first weeks, it is better to avoid very fatty and spicy foods, large amounts of raw vegetables, legumes, carbonated drinks, and other products that may cause bloating. The diet is expanded gradually depending on bowel function and food tolerance.

Special attention is paid to colostomy care. Before discharge, the patient is shown how to properly change the colostomy bag, clean the skin around the stoma, and monitor its condition. As recovery progresses, most patients gradually return to their usual daily life.

Overall recovery after the operation often takes about 6–8 weeks, but after a complex or emergency intervention, it may last longer.

Doctors at «Oxford Medical» recommend seeking urgent medical attention if the temperature rises, abdominal pain intensifies, repeated vomiting, redness, or discharge from the postoperative wound appears, or the colostomy suddenly stops functioning. Such symptoms may indicate the development of complications.

The cost of the operation depends on the method of surgical access, the complexity of the case, and the duration of the hospital stay. You can preliminarily review the current prices for medical services here. The surgeon will provide more precise information regarding the specifics of the operation and the price during the preliminary consultation. To make an appointment for a consultation with a surgeon, use the online appointment form on the website or call the contact center.

The information is for informational purposes and does not replace a consultation with a doctor.

Sources:

• World Society of Emergency Surgery

• US National Library of Medicine