The Hartmann procedure is an operation in which the rectum and a portion of bowel are surgically removed. This procedure is sometimes performed as an emergency procedure in cases where the bowel is perforated or obstructed. The Hartmann procedure is sometimes carried out in people with colorectal cancer, when these portions of the gastrointestinal system are so diseased that they are no longer functional.
Prior to undergoing a Hartmann operation, a patient might be evaluated for his or her overall physical health. This general health check is carried out to determine whether he or she is fit enough to undergo this physically stressful procedure. The health check might include X-rays, an electrocardiogram and blood tests. This preparation can be carried out only for a planned procedure, though, because when the operation is carried out as an emergency measure, there might not be sufficient time for a full series of tests.
After general anesthesia of the patient, the first stage in the Hartmann procedure is an incision made in the abdomen. Next, the abdomen is opened up to expose the bowel and rectum. The diseased portions of tissue are then identified and removed. Next, a stoma, or surgical hole, is created in the abdominal wall. The cut end of the bowel is connected to the stoma in order to allow fecal waste to exit the body.
In the final portion of the Hartmann procedure, the patient is fitted with a colostomy, a small external bag that collects the waste. For some people, the colostomy is reversible; for others, it might be permanent. Whether the colostomy is reversible depends on individual circumstances and cannot always be predicted in advance.
From start to finish, the Hartmann procedure typically takes between two and four hours. After the operation, a patient will stay in the hospital for five to 12 days, depending on his or her overall physical health and the outcome of the procedure. If the operation was carried out as a treatment for cancer, the patient might begin chemotherapy during this time.
For the first few days after the procedure, patients typically must follow a liquid diet to allow time for the bowel to heal. Most people can return to a modified version of their normal diet within a few days. Certain foods must be avoided to make care of the stoma and colostomy easier. Dietary modifications can be discussed with a nurse, dietitian or nutritionist before or after the surgery.
Full recovery takes several weeks. During this time, it is best to avoid heavy lifting and other strenuous activities. Long periods of inactivity also must be avoided, however, to prevent complications such as thrombosis. A regimen of short bursts of gentle exercise or light activity, alternated with rest periods, is recommended.