What Is Hartmann Reversal Procedure?

The Hartmann procedure is used to treat bowel problems.

A Hartmann procedure is a type of surgery that is performed for bowel problems. The most common reasons are bowel cancer and diverticular disease. Surgery involves removing the affected section of the bowel (colon) and creating an alternative path for the excrement to be passed. Once the affected part of the colon has been removed, the healthy end of the large bowel is brought to the surface of the abdomen to form a stoma (an opening for the waste). This type of opening is called a colostomy, which could be temporary or permanent. The non-functioning end of the bowel is usually sealed inside the abdomen. This procedure is usually performed during an emergency but can also be part of a planned surgery. The surgery can be performed either  laparoscopically or as an open surgery depending on the patient’s condition.

The Hartmann procedure is major surgery and can take about 90 to 180 minutes for the surgeon to complete the procedure.

• It is usually done under spinal or general anesthesia. The patient may be monitored throughout the procedure.
• This operation can be performed in one of two ways, either by laparoscopic method (keyhole surgery) or laparotomy (open procedure).
• A laparotomy involves making a large cut in the abdominal wall that allows the surgeon to operate on the bowel or intestine.
• Laparoscopic surgery is completed using a system of scopes inserted through three or four much smaller cuts in the abdomen.
• During the operation, the surgeon will remove the affected area of the bowel and create a colostomy.
• A colostomy is the end of the colon brought to the surface and stitched to the skin through a small cut in the abdomen.
• Fecal matter is then passed through the colostomy and collected in a bag that is fixed to the skin (stoma bag).

A Hartmann procedure is a major surgical procedure, which carries the risk of complications.

• Anesthesia risks like vomiting or aspiration
• Bleeding from the wounds or operation site
• Breakdown of the surgical wounds
• Chest infection due to aspiration during anesthesia
• Sepsis due to infection at the site of operation
• Deep vein thrombosis (clots in the veins of the legs)
• Pulmonary embolism (if the clot moves, it can travel to the lungs)
• Damage to the bowel
• Damage to the tubes that bring urine from the kidneys to the bladder
• Injury to the urinary bladder (organ that stores urine)
• Bruising or damage to the nearby organs or nerves, which may affect sexual function

Yes, the Hartmann procedure is reversible. The procedure is usually dependent on how much colon tube is remaining and the presence of any scar tissue. A short colon tube may lead to bowel management problems post surgery. These management problems can include increased frequency of passing stool, feeling of urgency or difficulty during evacuation. For most people, these symptoms will settle with time, but some may need medication and diet advice to manage their bowels post reversal.

The surgical procedure involves joining the part of the bowel (from which the colostomy is formed) and the rectal remnant together. This can be carried out by open or laparoscopic (keyhole) surgery. Usually, the procedure is done under general anesthesia.

The open surgery involves larger cuts over the abdomen and manipulating through the abdominal scar formed at the time of the initial operation.

Laparoscopic surgery involves minimal abdominal scarring and generally a quicker recovery.

The method used will depend upon the patient and surgeon. The reversal of the Hartmann procedure will allow the patient to pass excrement via their anus.

Most people make a good recovery. It is usual for the bowel to stop working for a few days. The patient may be able to go home after 5 to 10 days. It can take up to 3 months to return to normal activities. Regular exercise may help the patient to return to normal activities sooner depending on their condition.