Why Is Hartmann's Procedure Necessary?

Hartmann’s procedure is necessary to preserve the healthy part of the colon in conditions that most commonly include diverticulitis and colon cancer

Hartmann’s procedure is a surgical procedure in which an unhealthy part of your colon is cut from the rest of the colon, and the open end of the colon is connected to a bag outside the body through an opening in the skin (colostomy). It is done when some part of your colon becomes unhealthy due to some infectious or inflammatory process or due to cancer. 

Hartmann’s procedure helps prevent the infection or tumor from spreading to the healthy parts of the colon. It can be performed in either of the two ways:

• Open Hartmann’s procedure:  Open surgery or laparotomy in which a large incision is made in the abdomen.
• Laparoscopic Hartmann‘s procedure: The operation is done through small incisions using specialized equipment.

Hartmann’s procedure is necessary to preserve the healthy part of the colon in conditions that most commonly include:

• Diverticulitis:  Infection of the pouch formed in the intestine
• Colon cancer

Less commonly, the procedure may be done for: 

• Volvulus. Twisting of the intestine that results in loops
• Injury to the colon
  • During colonoscopy (insertion of a tube-like camera in your colon)
  • By a foreign body
  • Trauma (blow to the abdomen near the intestine)
• Crohn’s disease
• Trauma
• Rectal prolapse
• Ulcerative colitis
• Radiation injuries

• Enema is given the night before the surgery to clear your bowels.
• You need to fast 6 to 12 hours before the surgery as advised by your surgeon.
• A tube known as Foley’s catheter will be inserted in your bladder through your urethra to measure the urine output after the surgery.
• Fluids will be given through a needle inserted in your vein (intravenous).

• You are given medicine (general anesthesia) that makes you sleep throughout the procedure.
• You will be put on a ventilator with or without inserting a tube in your throat to allow you to breathe.
• Your surgeon will open your abdomen by making a large incision through your bellybutton.
• Your colon is retrieved and inspected to locate its unhealthy part. 
• The unhealthy part of the colon is then removed, and the rectal end of the colon is sealed off. 
• The end of the colon that is connected to the stomach is brought out of another incision made into the abdomen.
• This end of the colon is then tied to a colostomy bag where it can expel gas and stools. The colostomy bag can be changed as needed.
• The colon is sutured or stapled followed by suturing/stapling of the surgical wounds.
• The operation usually takes between two and four hours.

• You will be shifted to the surgical ward and monitored for several hours after the surgery.
• If you are an elderly person, you may experience diarrhea right after the procedure.
• Intravenous fluids will be continued as per your condition.
• You will be put on intravenous painkillers and antibiotics for three to seven days.
• You will be taught how to remove, clean, and put back the colostomy bag.
• You can resume drinking and eat right from the next day of the surgery or as advised by your surgeon.

• Wound infection (most common)
• Leaking of the colon
• Hernia (bulging of an organ through an abnormal opening in the abdomen)
• Paralytic ileus (paralysis of intestinal muscles)
• Wound dehiscence (reopening of the surgical wounds)
• Internal bleeding
• Damage to surrounding structures/organs
• Deep vein thrombosis (blood clot in the leg)
• Pulmonary embolism (blood clot in the lung)

• You will be encouraged to ambulate within one to two days after the surgery.
• You will be discharged five to ten days after the surgery with the necessary dietary instructions.
• You might feel constipated for which you will be prescribed mild laxatives.
• Avoid lifting heavy objects for at least six weeks after the surgery.
• It might take three months to one year after the surgery to return to your normal level of function.
• Resuming exercises-like walking-early after the surgery and doing them regularly might help you recover faster

Depending upon your condition, you may need to use the colostomy bag for a short term or permanently.

Your surgeon can reverse the Hartmann’s procedure by removing the seal of the rectum and freeing the end of colon connected to the colostomy. He will then join the two ends of the colon so that you can continue to pass stools normally as before. The opening of the colostomy will be sutured.

The Hartmann’s procedure reversal is recommended to be performed at least six months after the previous Hartmann’s procedure.