A proctosigmoidectomy, Hartmann's operation or Hartmann's procedure is the surgical resection of the rectosigmoid colon with closure of the anorectal stump and formation of an end colostomy. 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 ...

inflammation Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', '' ...

(proctosigmoiditis, proctitis,

diverticulitis Diverticulitis, also called colonic diverticulitis, is a gastrointestinal disease characterized by inflammation of abnormal pouches—Diverticulum, diverticula—that can develop in the wall of the large intestine. Symptoms typically include lo ...

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 symp ...

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

anastomosis An anastomosis (, : 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, or streams. Such a connection may be normal (su ...

is not possible, or more rarely it is used palliatively in patients with colorectal tumours. The Hartmann's procedure with a proximal end colostomy or ileostomy 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 (: stomata, from Greek language, Greek ''στόμα'', "mouth"), also called a stomate (: stomates), is a pore found in the Epidermis (botany), epidermis of leaves, stems, and other organs, that controls the rate of gas exc ...

. 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 covering of the abdominal organs. Symptoms may include severe pain, swelling of the abdomen, fever, or weight loss. One pa ...

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 :d. Elective resection of rectal cancer or distal colon cancer in patients deemed unfit for anterior resection with anastomosis 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. 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