Aproctosigmoidectomy,Hartmann's operation orHartmann's procedure is the surgicalresection of therectosigmoid colon with closure of the anorectal stump and formation of an endcolostomy. It was used to treatcolon cancer orinflammation (proctosigmoiditis, proctitis,diverticulitis,volvulus, etc.). Currently, its use is limited to emergency surgery when immediateanastomosis is not possible, or more rarely it is usedpalliatively in patients with colorectal tumours.[1]
The Hartmann's procedure with a proximal endcolostomy orileostomy 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 astoma.
The indications for this procedure include:
a. Localized or generalizedperitonitis 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 safeanastomosis
d. Elective resection of rectal cancer or distal colon cancer in patients deemed unfit for anterior resection with anastomosis[3]
Use of the Hartmann's procedure initially had a mortality rate of 8.8%.[4] 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.[5]
The procedure was first described in 1921 by French surgeonHenri Albert Hartmann.[6] The original two-paragraph article in French together with an English translation by Thomas Pézier[7] and a modern commentary is available.[8] The procedure is described in detail in his book,Chirurgie du Rectum, which was published in 1931 and constituted volume 8 of hisTravaux de Chirurgie.[9]
^Balanzoni S, Perrucci A, Pasi L, Montanari M (1997). "The Hartmann intervention. The current indications and the authors' own experience".Minerva Chir.52 (4):383–6.PMID9265121.
.jpg)