The Hartmann procedure

Abstract

The Hartmann procedure During a 10-year period, 59 patients had a Hartmann operation f o r diverticular disease ( n = 19), carcinoma ( n = 21), anastomotic disruption ( n = 5 ) , injury ( n = 3 ) and various other conditions ( n = I I ) . Twenty-two patients (37.3 per cent) died postoperatively.Wound infection or wound dehiscence occurred in 24 patients. Other complications inherent in this operation were colostomy necrosis or retraction ( n = 12) and leakage of the rectal stump (n = 3 ) . The mean hospital stay of the surviving patients was 28.4 days. Colorectal continuity was subsequently restored in 12 patients (32.4 per cent) and no difJulties were encountered with this procedure.

Surgical practices for malignant left colonic obstruction in Germany

“…This result argues against the use of a protective stoma after left-colon resection. In the low anterior resection of M A N U S C R I P T Hospital mortality was 7.7% overall (n = 57) and was thus lower than reported in the literature [2,4,6,7,8,14], with only marginal and statistically insignificant differences between the groups. The hospital mortality after Hartmann resection was slightly lower than in the other groups, although patients in this group were disadvantaged in respect both of risk profile and of tumour status.…”

“…Furthermore, in many instances, after a Hartmann resection the second step of restoring continuity is not carried out at all [2,4,6,7,8]. Boland et al [22] report that the restoration was associated with extensive lysis of adhesions in 69% of cases, with minor complications in 40% and major complications in 38% of patients, a early mortality of 3% and failure of the planned restoration in 8% of cases due to intra-operative problems.…”

“…Whenever possible, even in emergencies, an oncologically adequate procedure with systematic lymph-node dissection should be aimed at [1]. After removal of the affected section of the bowel, the discontinuity can be treated by Hartmann's procedure, or continuity can be restored by anastomosis, if necessary with the use of a protective stoma [2,3,4,5,6,7,8]. In spite of the repeatedly reported advantages of primary restitution of continuity [3,9,10], the Hartmann operation is still of value [2,4,5,6,7,8].…”

Use of Hartmann’s procedure in England

“…Hartmann's procedure has also been extensively used in the treatment of acute complicated diverticular disease particularly as an alternative to a three stage procedure [4]. Hartmann's procedure was originally envisaged as being permanent; restoration of intestinal continuity has however been successfully achieved in many patients [5][6][7][8][9].…”

Internal Iliac Pseudoaneurysm Rupture Attributed to Perforated Hartmann’s Pouch Diagnosed on CT

“…This procedure may be performed for resection of a rectosigmoid carcinoma, complicated diverticulitis, or penetrating trauma [3]. Possible rare life threatening complications of the Hartmann procedure include leakage or even blowout of the blind-ending rectal or colonic stump [3,4].…”