Hartmann's procedure for carcinoma of rectum and distal sigmoid colon: 5-year audit

During a 5-year period, 32 patients with colorectal carcinoma underwent a Hartmann procedure. Twenty operations were performed as emergencies for obstruction or peritonitis, and 12 for the elective treatment of colorectal malignancies. Of 22 surviving patients with potentially curable resections, 17 had restoration of colorectal continuity without complication. Five patients refused this option. Of the nine palliative procedures, seven patients developed a pelvic recurrence, one developed metastatic disease, and the remaining patient died after surgery. The median hospital stay was 17 days (range 8-48 days). There were two postoperative deaths (6%), both from pulmonary emboli. Thrombotic events occurred in three further patients, and wound sepsis in four. Other complications inherent to this procedure were individual cases of pelvic sepsis, anastomotic stricture, and a failed initial attempt at 'reversal'. These findings confirm that this operation is safe and effective in dealing with rectal and distal sigmoid colon malignancies with potential for local recurrence, and in those presenting as an emergency with obstruction or peritonitis, particularly when the operator is a surgical trainee.