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The utility of the Hartmann procedure

D C Desai1, E J Brennan, J F Reilly

  • 1Department of Surgery, Lankenau Hospital, Wynnewood, Pennsylvania, 19096, USA.

American Journal of Surgery
|March 27, 1998
PubMed
Summary

The Hartmann procedure is a safe surgical option for rectosigmoid conditions. This study shows acceptable morbidity and mortality, with a low-risk second stage for bowel restoration.

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Area of Science:

  • Colorectal Surgery
  • Surgical Oncology
  • Gastroenterology

Background:

  • The Hartmann procedure, described in 1923 for rectosigmoid cancer, has expanded indications.
  • It is now used for complicated diverticulitis, ischemic bowel, perforations, volvulus, and colitis.

Purpose of the Study:

  • To evaluate the outcomes of the Hartmann procedure.
  • To assess indications, morbidity, mortality, and the success of the second-stage operation.

Main Methods:

  • Retrospective review of 185 patients undergoing the Hartmann procedure (1981-1995).
  • Analysis of patient charts for indications, complications, and mortality.

Main Results:

  • Complicated diverticulitis (108 patients) and rectosigmoid cancer (31 patients) were primary indications.
  • In-hospital mortality was 14% (27 deaths), with overall complications <9%.
  • Of 158 survivors, 57% had a second stage with no mortality and <4% complications.

Conclusions:

  • This series demonstrates lower mortality than other reports.
  • The second stage is safe with minimal morbidity and no mortality in selected patients.
  • The Hartmann procedure is a safe and effective option for complex rectosigmoid pathology.

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