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Hartmann's operation

L D Rosenman1

  • 1Department of Surgery, Mount Zion Hospital, University of California, San Francisco.

American Journal of Surgery
|September 1, 1994
PubMed
Summary
This summary is machine-generated.

Hartmann

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Area of Science:

  • Surgical oncology
  • Colorectal surgery

Background:

  • The term "Hartmann's operation" is frequently misapplied in contemporary surgical practice.
  • Complications such as poor wound healing are often linked to incorrect execution of the procedure.

Purpose of the Study:

  • To clarify the original description of Hartmann's procedure for rectal cancer.
  • To differentiate the correct technique from common misapplications.
  • To discuss the anatomical and vascular rationale for the original procedure.

Main Methods:

  • Review of the historical description of Hartmann's procedure.
  • Analysis of anatomical landmarks, specifically the peritoneal reflection.
  • Discussion of vascular supply to the distal rectum via the inferior hemorrhoidal arteries.

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Main Results:

  • Hartmann's original procedure involved rectal transection and closure at or below the peritoneal reflection.
  • This anatomical location ensures adequate blood supply from the inferior hemorrhoidal arteries for healing.
  • Misapplication often involves a longer rectal stump with compromised vascularity.

Conclusions:

  • Accurate understanding and application of Hartmann's procedure are crucial for preventing complications.
  • Adherence to the original technique, particularly regarding the level of rectal transection, is vital for surgical success.
  • The vascular supply at the peritoneal reflection is key to the procedure's efficacy.