What is a Hartmann’s procedure?

A Hartmann’s procedure is an operation that is usually performed in an emergency situation where a segment of the colon is resected, and the two ends of the bowel are not re-joined. Instead the colon is brought up through the abdominal wall muscles and sutured to the skin (a stoma). Stools that come out of the stoma are collected in a bag that covers it. The lower end of the large bowel (usually rectum) has been closed and left inside your abdomen.

What is a reversal of Hartmann’s procedure?

If the stoma is intended to be temporary and re-joining the bowel is feasible, then you will need another operation to join the bowel together. This involves taking down the stoma and joining this part to the lower end of the colon (usually rectum) that has been closed and left behind in the previous operation.

Although the aim of this operation is to remove the stoma, there is a small chance that you may need a smaller temporary stoma (ileostomy) to allow faeces to bypass the new anastomosis and give it time to heal. This stoma can be reversed between three to six months later.

In rare situations, it may not be technically possible to reverse the stoma. This may only be apparent during surgery and forces the surgeon to leave the stoma and not reverse it.

What are the risks associated with this operation?

  • Anastomotic leak – Sometimes the bowel anastomosis (join) leaks. This could range from a mild leak that can be managed with antibiotics to a sever one that results in severe infection and the need for urgent surgery. The risk is approximately 5% or 1 in 20
  • Post-operative bleeding – Blood transfusion may be needed to replace lost blood. Occasionally urgent surgery is needed to stop the bleeding
  • Damage to the ureter – The ureter is the tube that brings urine from the kidney to the bladder is located immediately behind the colon and rarely it gets injured during surgery. This may require further surgery for repair
  • Bladder dysfunction – Bladder may not empty properly or may empty without warning. This is due to injury to the nerves supplying the bladder during the surgery
  • Sexual dysfunction – Men may be unable to get an erection or keep an erection. It may also mean that they cannot ejaculate. In women it may cause pain during or after intercourse. For most men and women, this improves with time
  • Ileus – The bowel is paralysed leading to abdominal bloating, and vomiting. You will be asked to fast until there is evidence of passage of stool or flatus. A tube may be passed into the stomach through the nose to suction the stomach to prevent vomiting and aspiration
  • Small bowel obstruction – Adhesions (bands of scar tissue) may develop inside the abdomen and the bowel may block. This is a short term and long-term complication. Most small bowel obstructions resolve with non-operative management, but some may need further surgery
  • Incisional hernia – Hernias can develop over port sites or specimen extraction sites during laparoscopic surgery and over the long incision of open surgery
  • Change in bowel habit – Bowel habits will change. Bowel function may be erratic. Stools may be looser, smaller and more frequent. There may be some leakage of stools particularly at night depending on the type of surgery. In most people, this improves with time, without further treatment
  • Wound infection
  • Urinary tract infection

There are other general risks associated with surgery

  • DVT – Blood clot in the leg (DVT) causing pain and swelling. In rare cases part of the clot may break off and go to the lungs
  • Chest infection
  • Heart attack or stroke could occur due to the strain on the heart.
  • Death, as a result of this procedure, is rare but possible (~1%).