Hartmann's operation: does it still have a place? - abstract

ABSTRACT

In 1923 Hartmann described an operation where, for an advanced rectal carcinoma, he completely excluded the rectum and brought out an end sigmoid colostomy. Since then, this procedure has been widely used for cases where rectal anastomosis is regarded as unsafe. In 23 consecutive cases in which Hartmann's operation was indicated (gangrenous sigmoid volvulus 3, trauma 6, pelvic sepsis 9, tumour 6) the authors elected to do an "unsafe" anastomosis with a totally defunctioning proximal colostomy. Only two (2) cases developed complications (minor). Hartmann's operation should only be done in the situation where there is absolutely no intention to restore gut continuity as pelvic dissection to reconstitute the gut can be very difficult. If rectal anastomosis is regarded as unsafe it should still be carried out and a defunctioning colostomy done since the second stage only involves colostomy closure (AU)