Hartmann's operation
Encyclopedia
Hartmann's operation is the surgical resection
of the rectosigmoid colon
with closure of the rectal stump and formation of an end colostomy
. It was used to treat colon cancer or diverticulitis
. These days its use is limited to emergency surgery when immediate anastomosis
is not possible, or more rarely it is used palliatively in colorectal tumours. The procedure was first described by Henri Albert Hartmann
in 1921. 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.
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
.
The indications for this procedure include:
Use of the Hartmann's procedure has been associated with a low perioperative mortality of 9%, but at the cost of a colostomy that, in up to two-thirds of patients, is never reversed.
Segmental resection
Segmental resection is a surgical procedure to remove part of an organ or gland. It may also be used to remove a tumor and normal tissue around it. In lung cancer surgery, segmental resection refers to removing a section of a lobe of the lung.- External links :* entry in the public domain NCI...
of the rectosigmoid colon
Rectosigmoid colon
The Rectosigmoid colon refers to the rectum and sigmoid colon considered together. The junction is at the proximal part of the rectum and the distal part of the sigmoid colon....
with closure of the rectal stump and formation of an end colostomy
Colostomy
A colostomy is a surgical procedure in which a stoma is formed by drawing the healthy end of the large intestine or colon through an incision in the anterior abdominal wall and suturing it into place. This opening, in conjunction with the attached stoma appliance, provides an alternative channel...
. It was used to treat colon cancer or diverticulitis
Diverticulitis
Diverticulitis is a common digestive disease particularly found in the large intestine. Diverticulitis develops from diverticulosis, which involves the formation of pouches on the outside of the colon...
. These days its use is limited to emergency surgery when immediate anastomosis
Anastomosis
An anastomosis is the reconnection of two streams that previously branched out, such as blood vessels or leaf veins. The term is used in medicine, biology, mycology and geology....
is not possible, or more rarely it is used palliatively in colorectal tumours. The procedure was first described by Henri Albert Hartmann
Henri Albert Hartmann
Henri Albert Hartmann was a French surgeon. He wrote numerous papers on a wide variety of subjects, ranging from war injuries to shoulder dislocations to gastrointestinal cancer...
in 1921. 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.
The Hartmann's procedure with a proximal end colostomy
Colostomy
A colostomy is a surgical procedure in which a stoma is formed by drawing the healthy end of the large intestine or colon through an incision in the anterior abdominal wall and suturing it into place. This opening, in conjunction with the attached stoma appliance, provides an alternative channel...
or ileostomy
Ileostomy
An ileostomy is a surgical opening constructed by bringing the end or loop of small intestine out onto the surface of the skin. Intestinal waste passes out of the ileostomy and is collected in an external pouching system stuck to the skin...
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
Stoma
In botany, a stoma is a pore, found in the leaf and stem epidermis that is used forgas exchange. The pore is bordered by a pair of specialized parenchyma cells known as guard cells that are responsible for regulating the size of the opening...
.
The indications for this procedure include:
- a. Localized or generalized peritonitisPeritonitisPeritonitis is an inflammation of the peritoneum, the serous membrane that lines part of the abdominal cavity and viscera. Peritonitis may be localised or generalised, and may result from infection or from a non-infectious process.-Abdominal pain and tenderness:The main manifestations of...
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 anastomosisAnastomosisAn anastomosis is the reconnection of two streams that previously branched out, such as blood vessels or leaf veins. The term is used in medicine, biology, mycology and geology....
.
Use of the Hartmann's procedure has been associated with a low perioperative mortality of 9%, but at the cost of a colostomy that, in up to two-thirds of patients, is never reversed.