Hartmann’s Procedure: Everything You Need to Know

Table of ContentsView AllTable of ContentsWhat It IsPurposeHow to PrepareDay of SurgeryRecovery

Table of ContentsView All

View All

Table of Contents

What It Is

Purpose

How to Prepare

Day of Surgery

Recovery

Hartmann’s procedure (clinically referred to as proctosigmoidectomy) is a surgery that takes on inflammatory conditions and cancer of the colon. It’s most often used to treat complicated cases ofdiverticulitis, an infection of the outpouchings (diverticula) in the lining of the colon, and colon cancer.

The aim of this surgery is to remove problematic tissue and connect the healthy portion of the colon to the skin, which allows stool to pass out through an opening in the abdomen. Patients that are healthy enough to undergo it may have a second procedure, called “reversal,” which involves reconnecting the healthy portions of the colon and restoring normal function.

This complicated treatment requires significant preparation, a lengthy hospital stay, as well as lifestyle changes afterward. It’s important to understand the basics of how Hartmann’s procedure works, how to prepare, and what life looks like after this procedure.

What Is Hartmann’s Procedure?

Whether taking on diverticulitis, colon cancer, or other conditions, the goal of Hartmann’s procedure is the same—to get rid of problematic colon tissue.This prevents the infection or cancer from spreading while also removing obstructions from this part of the body. In cancer cases, this procedure is most often an emergency surgery.

Surgery is not the preferred initial treatment for mild-to-moderate cases of diverticulitis. The healthcare provider may first prescribe antibiotics and recommend lifestyle adjustments to treat the condition before indicating surgery. However, in severe cases where infection or stool are present throughout the abdomen, this procedure is considered to be a first-line therapy.

Both open and less-invasive laparoscopic techniques can be used to perform Hartmann’s procedure. While you’re under general anesthesia, surgeons locate and remove the cancerous or inflamed portion of the colon, sealing off the healthy parts.

They then re-route the healthy portion of the digestive tract through the abdomen and connect it to the skin. This opening (called a “stoma”) in the abdomen is then connected to a colostomy bag, which is used to collect stool. Finally, the healthy portion of the remaining colon is sealed. The incision (for open surgery) or multiple incisions (for laparoscopy) are then stitched shut.

Contraindications

As with all major surgeries, Hartmann’s procedure may not be the best option for some patients. Particular concern surrounds patients over the age of 70 years of age; while the procedure can be safe for this group, the presence of other medical conditions can complicate matters.

A history of any of the conditions may contraindicate surgery for this population:

In addition, a number of other factors have been associated with higher complication rates, including:

While the above aren’t necessarily outright contraindications, they are factors that the healthcare provider may consider as they decide on a treatment plan. However, this procedure is often done emergently. In such cases, the benefit of surgery is determined to outweigh the risks.

Potential Risks

As hard as surgeons work to ensure that Hartmann’s procedure is safe and effective, there’s always a chance of complications. What can happen? Here’s a breakdown:

Purpose of Hartmann’s Procedure

Primarily, this surgery is called for in cases of severe inflammation, infection, or cancer growth in the colon. These arise due to several conditions:

Critical to the success of Hartman’s procedure is proper testing and diagnosis. Here’s a breakdown of what may be done:

Proper preparation for Hartmann’s procedure, as with any major surgery, is as essential for the patient as it is for the medical team. Since this treatment impacts the lower-digestive system, it requires a number of significant pre-operative lifestyle changes, and, since a hospital stay is needed afterwards, you have to plan ahead.

While you’ll get a good deal of guidance from your surgeon and medical staff, it’s important to have an understanding of what you can expect and how to get ready.

Location

Whether performed as an open surgery or laparoscopically, Hartmann’s procedure is performed in the surgery ward of a hospital. Here’s a quick rundown of what you can expect to find there:

What to Wear

On the day of surgery, aim to dress comfortably. You’ll get pre-operative instructions from your surgeon, but here are some guidelines:

Food and Drink

Given that Hartmann’s procedure impacts the digestive system, dietary changes need to be made to prepare you for the surgery. Here are some keys to the pre-operative diet:

Why You Can’t Eat or Drink Before Surgery

Medications

In preparation for Hartmann’s procedure, your surgeon may ask you to do a bowel prep regimen, aimed at healthily and safely emptying your bowels the day before surgery. Specific instructions vary, and not every surgeon will ask you to do this, but here’s what you can expect:

Colonoscopy Prep: Poop Color Chart

To avoid the risk of excessive bleeding or other unintended effects, your surgeon will need to go through the prescribed and over-the-counter medications, vitamins, and herbal supplements that are part of your regimen. In particular, let your healthcare provider know if you’re taking any of the following as dosages may need to be adjusted or temporarily cut off:

It’s absolutely essential that you give your healthcare provider a full accounting of what you’ve been prescribed and what you’re taking.

What to Bring

So what do you need to bring along as you prepare for your stay in the hospital? Don’t forget the following:

Pre-Op Lifestyle Changes

Aside from the liquid diet mentioned above, there will also be a couple of lifestyle changes needed to ensure good outcomes. These include:

Your surgeon may have specific instructions for you; be sure to follow their recommendations closely.

What to Expect on the Day of Surgery

On the day of surgery, a great deal happens. Not only does Hartmann’s procedure, itself, have to be performed, but the medical team also needs to check that you’re ready for surgery, and make sure your in-hospital recovery is going well.

Before the Surgery

Your first stop will be the pre-op room, where you’ll change into a hospital gown and have a final medical evaluation and consultation. Here’s what happens:

During the Surgery

Hartmann’s procedure takes anywhere from two to four hours. Specific techniques vary between laparoscopic and open surgery approaches, with the former becoming the more frequently preferred option. Here’s a quick breakdown of the first stage:

Typically, you’ll wake up in the operating room, and once the surgeon is sure you’re stable, you’ll be taken to a post-operative recovery room.

After the Surgery

Hartmann’s procedure is a major surgery and requires up to 10 days of in-hospital recovery. As you recover from surgery, nurses will be checking in with you to ensure there are no complications or problems. What can you expect? Here’s a quick rundown:

Physical activity:Within 12 hours of surgery, you’ll be asked to stand up with assistance; this helps prevent the formation of blood clots. As you recover, you’ll need to gradually increase activity, taking

When can you go home? To be discharged, your surgeon needs to see:

Depending on the case, it can take anywhere from three months to one year to see complete recovery from Hartmann’s procedure. Typically, the first follow-up appointment is one to three weeks after surgery, with additional appointments scheduled as needed.

What’s the recovery timeline look like? When can you resume your normal activities? Here’s what you need to keep in mind:

As you recover at home, you’ll also need to manage common side-effects of treatment, including:

Healing

Making sure your incisions heal properly is another important aspect of recovery from Hartmann’s procedure. Here are some tips to care for them:

Coping With Recovery

The impact of a surgery like Hartmann’s procedure goes beyond the body; it can also affect your mental health. Multiple studies have found post-operative patients of colorectal surgeries were found to have higher rates of depression and anxiety.Recovery is challenging and exhausting, and you’re far from alone if you’re struggling.

That said, there are some strategies to take on mental health challenges after surgery:

Possible Future Surgeries

While Hartmann’s procedure does often lead to terminal use of the colostomy bag, some patients may be able to have revision surgery. In this procedure, performed under general anesthesia, the surgeon reconnects the healthy portions of the colon, and closes the stoma.In addition, the surgeon may use mesh to reinforce the abdominal wall.

This procedure occurs three to six months after the first as the surgeon needs to ensure that everything has healed completely. You and your healthcare provider will talk about your options.

Lifestyle Adjustments

Over the longer term after Hartmann’s procedure, a number of broader lifestyle changes can be made to maintain positive results. These include:

As intense as recovery from Hartmann’s procedure can be, it can be an opportunity to make positive changes in your life.

13 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.NYU Langone Health.Surgery for diverticular disease.Hallam S, Mothe BS, Tirumulaju R.Hartmann’s procedure, reversal and rate of stoma-free survival.Ann R Coll Surg Engl. 2018;100(4):301-307. doi:10.1308/rcsann.2018.0006Rogenbogen S, Hardimann K, Hendren S, Morris A.Surgery for diverticulitis in the 21st century: a systematic review.JAMA Surg. 2014;149(3):292-303. doi:10.1001/jamasurg.2013.5477Fiscon V, Portale G, Mazzeo A, Migliorini G, Frigo F.Hartmann’s reversal: laparoscopic technique.J of Laparoendosc Adv Surg Tech. 2015;25(2). doi:10.1089/vor.2014.0227Kirchhoff P, Clavien P, Hahnloser D.Complications in colorectal surgery: Risk factors and preventive strategies.Patient Saf Surg. 2010;4(1):5. doi:10.1186/1754-9493-4-5Costantini R.Hartmann’s procedure for complicated diverticulitis: a critical reappraisal.Open Anesth J. 2019;13(1):121-131. doi:10.2174/2589645801913010121Medscape.Laparoscopic Hartmann procedure technique.Cleveland Clinic.Hartmann’s procedure.Memorial Sloan Kettering Cancer Center.About your colon resection surgery. 2020.Weill Cornell Medical Center.Pre-op education for colorectal surgery.American College of Surgeons.Medication and surgery: before your operation.Zangenberg M, El-Hussuna A.Psychiatric morbidity after surgery for inflammatory bowel disease: A systematic review.World J Gastroenterol. 2017;23(48):8651-8659. doi:10.3748/wjg.v23.i48.8651Harvard Men’s Health Watch.The mental side of recovery.

13 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.NYU Langone Health.Surgery for diverticular disease.Hallam S, Mothe BS, Tirumulaju R.Hartmann’s procedure, reversal and rate of stoma-free survival.Ann R Coll Surg Engl. 2018;100(4):301-307. doi:10.1308/rcsann.2018.0006Rogenbogen S, Hardimann K, Hendren S, Morris A.Surgery for diverticulitis in the 21st century: a systematic review.JAMA Surg. 2014;149(3):292-303. doi:10.1001/jamasurg.2013.5477Fiscon V, Portale G, Mazzeo A, Migliorini G, Frigo F.Hartmann’s reversal: laparoscopic technique.J of Laparoendosc Adv Surg Tech. 2015;25(2). doi:10.1089/vor.2014.0227Kirchhoff P, Clavien P, Hahnloser D.Complications in colorectal surgery: Risk factors and preventive strategies.Patient Saf Surg. 2010;4(1):5. doi:10.1186/1754-9493-4-5Costantini R.Hartmann’s procedure for complicated diverticulitis: a critical reappraisal.Open Anesth J. 2019;13(1):121-131. doi:10.2174/2589645801913010121Medscape.Laparoscopic Hartmann procedure technique.Cleveland Clinic.Hartmann’s procedure.Memorial Sloan Kettering Cancer Center.About your colon resection surgery. 2020.Weill Cornell Medical Center.Pre-op education for colorectal surgery.American College of Surgeons.Medication and surgery: before your operation.Zangenberg M, El-Hussuna A.Psychiatric morbidity after surgery for inflammatory bowel disease: A systematic review.World J Gastroenterol. 2017;23(48):8651-8659. doi:10.3748/wjg.v23.i48.8651Harvard Men’s Health Watch.The mental side of recovery.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

NYU Langone Health.Surgery for diverticular disease.Hallam S, Mothe BS, Tirumulaju R.Hartmann’s procedure, reversal and rate of stoma-free survival.Ann R Coll Surg Engl. 2018;100(4):301-307. doi:10.1308/rcsann.2018.0006Rogenbogen S, Hardimann K, Hendren S, Morris A.Surgery for diverticulitis in the 21st century: a systematic review.JAMA Surg. 2014;149(3):292-303. doi:10.1001/jamasurg.2013.5477Fiscon V, Portale G, Mazzeo A, Migliorini G, Frigo F.Hartmann’s reversal: laparoscopic technique.J of Laparoendosc Adv Surg Tech. 2015;25(2). doi:10.1089/vor.2014.0227Kirchhoff P, Clavien P, Hahnloser D.Complications in colorectal surgery: Risk factors and preventive strategies.Patient Saf Surg. 2010;4(1):5. doi:10.1186/1754-9493-4-5Costantini R.Hartmann’s procedure for complicated diverticulitis: a critical reappraisal.Open Anesth J. 2019;13(1):121-131. doi:10.2174/2589645801913010121Medscape.Laparoscopic Hartmann procedure technique.Cleveland Clinic.Hartmann’s procedure.Memorial Sloan Kettering Cancer Center.About your colon resection surgery. 2020.Weill Cornell Medical Center.Pre-op education for colorectal surgery.American College of Surgeons.Medication and surgery: before your operation.Zangenberg M, El-Hussuna A.Psychiatric morbidity after surgery for inflammatory bowel disease: A systematic review.World J Gastroenterol. 2017;23(48):8651-8659. doi:10.3748/wjg.v23.i48.8651Harvard Men’s Health Watch.The mental side of recovery.

NYU Langone Health.Surgery for diverticular disease.

Hallam S, Mothe BS, Tirumulaju R.Hartmann’s procedure, reversal and rate of stoma-free survival.Ann R Coll Surg Engl. 2018;100(4):301-307. doi:10.1308/rcsann.2018.0006

Rogenbogen S, Hardimann K, Hendren S, Morris A.Surgery for diverticulitis in the 21st century: a systematic review.JAMA Surg. 2014;149(3):292-303. doi:10.1001/jamasurg.2013.5477

Fiscon V, Portale G, Mazzeo A, Migliorini G, Frigo F.Hartmann’s reversal: laparoscopic technique.J of Laparoendosc Adv Surg Tech. 2015;25(2). doi:10.1089/vor.2014.0227

Kirchhoff P, Clavien P, Hahnloser D.Complications in colorectal surgery: Risk factors and preventive strategies.Patient Saf Surg. 2010;4(1):5. doi:10.1186/1754-9493-4-5

Costantini R.Hartmann’s procedure for complicated diverticulitis: a critical reappraisal.Open Anesth J. 2019;13(1):121-131. doi:10.2174/2589645801913010121

Medscape.Laparoscopic Hartmann procedure technique.

Cleveland Clinic.Hartmann’s procedure.

Memorial Sloan Kettering Cancer Center.About your colon resection surgery. 2020.

Weill Cornell Medical Center.Pre-op education for colorectal surgery.

American College of Surgeons.Medication and surgery: before your operation.

Zangenberg M, El-Hussuna A.Psychiatric morbidity after surgery for inflammatory bowel disease: A systematic review.World J Gastroenterol. 2017;23(48):8651-8659. doi:10.3748/wjg.v23.i48.8651

Harvard Men’s Health Watch.The mental side of recovery.

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