A proctosigmoidectomy, Hartmann's operation or Hartmann's procedure is the surgical resection of the

rectosigmoid colon The large intestine, also known as the large bowel, is the last part of the gastrointestinal tract and of the digestive system in tetrapods. Water is absorbed here and the remaining waste material is stored in the rectum as feces before being rem ...

with closure of the anorectal stump and formation of an end

colostomy A colostomy is an opening ( stoma) in the large intestine (colon), or the surgical procedure that creates one. The opening is formed by drawing the healthy end of the colon through an incision in the anterior abdominal wall and suturing it int ...

. It was used to treat

colon cancer Colorectal cancer (CRC), also known as bowel cancer, colon cancer, or rectal cancer, is the development of cancer from the colon or rectum (parts of the large intestine). Signs and symptoms may include blood in the stool, a change in bowel mo ...

inflammation Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritants, and is a protective response involving im ...

(proctosigmoiditis, proctitis,

diverticulitis Diverticulitis, specifically colonic diverticulitis, is a gastrointestinal disease characterized by inflammation of abnormal pouches—diverticula—which can develop in the wall of the large intestine. Symptoms typically include lower abdominal ...

volvulus A volvulus is when a loop of intestine twists around itself and the mesentery that supports it, resulting in a bowel obstruction. Symptoms include abdominal pain, abdominal bloating, vomiting, constipation, and bloody stool. Onset of symptoms m ...

, etc.). Currently, its use is limited to emergency surgery when immediate

anastomosis An anastomosis (, plural anastomoses) is a connection or opening between two things (especially cavities or passages) that are normally diverging or branching, such as between blood vessels, leaf#Veins, leaf veins, or streams. Such a connection m ...

is not possible, or more rarely it is used palliatively in patients with colorectal tumours. The Hartmann's procedure with a proximal end

ileostomy Ileostomy is a stoma (surgical opening) constructed by bringing the end or loop of small intestine (the ileum) out onto the surface of the skin, or the surgical procedure which creates this opening. Intestinal waste passes out of the ileostomy an ...

is the most common operation carried out by general surgeons for management of malignant obstruction of the distal colon. During this procedure, the lesion is removed, the distal bowel closed intraperitoneally, and the proximal bowel diverted with a

stoma In botany, a stoma (from Greek ''στόμα'', "mouth", plural "stomata"), also called a stomate (plural "stomates"), is a pore found in the epidermis of leaves, stems, and other organs, that controls the rate of gas exchange. The pore is bor ...

. The indications for this procedure include: :a. Localized or generalized

peritonitis Peritonitis is inflammation of the localized or generalized peritoneum, the lining of the inner wall of the abdomen and cover of the abdominal organs. Symptoms may include severe pain, swelling of the abdomen, fever, or weight loss. One part or ...

caused by perforation of the bowel secondary to the cancer :b. Viable but injured proximal bowel that, in the opinion of the operating surgeon, precludes safe

:c. Complicated diverticulitis Use of the Hartmann's procedure initially had a mortality rate of 8.8%. Currently, the overall mortality rate is lower but varies greatly depending on indication for surgery. One study showed no statistically significant difference in morbidity or mortality between laparoscopic versus open Hartmann procedure.

Etymology and history

The procedure was first described in 1921 by French surgeon

Henri Albert Hartmann Henri Albert Hartmann (16 June 1860 – 1 January 1952) was a French surgeon. He wrote numerous papers on a wide variety of subjects, ranging from war injuries to shoulder dislocations to gastrointestinal cancer. Hartmann is best known for Hartm ...

. The original two-paragraph article in French together with an English translation by Thomas Pézier and a modern commentary is available. The procedure is described in detail in his book, ''Chirurgie du Rectum'', which was published in 1931 and constituted volume 8 of his ''Travaux de Chirurgie''.

References

{{DEFAULTSORT:Hartmann's Operation Surgical oncology Surgical removal procedures Digestive system surgery