The Hartmann procedure (proctosigmoidectomy) is a surgical operation that involves removing a diseased portion of the sigmoid colon or upper rectum, closing the remaining rectal stump, and creating a temporary or permanent end colostomy.
It is most frequently performed as an emergency life-saving measure when it is unsafe to immediately reconnect the two ends of the bowel.
The surgical resection of the rectosigmoid colon with closure of the rectal stump and formation of an end colostomy.
It is used to treat colon cancer or diverticulitis.
Use is limited to emergency surgery when immediate anastomosis is not possible, or more rarely it is used palliatively in colorectal tumors.
The procedure with a proximal end colostomy or ileostomy is the most common operation carried out by general surgeons for management of malignant obstruction of the distal colon.
During the procedure, the lesion is removed, the distal bowel closed intraperitoneally, and the proximal bowel diverted with a stoma.
Components of the Procedure
Resection: The surgeon removes the damaged or diseased section of the large intestine, typically the sigmoid colon.
Rectal Closure: The lower part of the bowel (the rectal stump) is sewn or stapled shut, remaining inside the body as a “blind pouch”.
Colostomy Formation: The upper part of the healthy colon is brought through an opening in the abdominal wall, a stoma, to allow waste to exit the body into a colostomy bag.
Associated with a low perioperative mortality of 9%.
This procedure is typically used in situations where immediate reattachment/ anastomosis is risky due to inflammation or infection:
Complicated Diverticulitis: Perforation of the bowel or severe infection/abscess
Indications for this procedure include: a. Localized or generalized peritonitis caused by perforation of the bowel secondary to cancer, or diverticulitis.
b. Viable but injured proximal bowel that precludes safe anastomosis.
Colorectal Cancer: Obstructing tumors that prevent normal bowel function.
Trauma: Severe injury to the colon or rectum.
Volvulus: Twisting of the sigmoid colon.
Reversal and Recovery
In many cases, the procedure is temporary.
Once the patient has recovered and inflammation has subsided (often after 3–6 months), a second surgery called a Hartmann reversal can be performed to reconnect the colon to the rectum and close the stoma.
Permanence: Not all Hartmann procedures are reversed. For some high-risk or elderly patients, the colostomy may remain permanent if the risks of a second major surgery are too high.
As it is often an emergency surgery, it carries significant risks, including wound infection, internal bleeding, and a mortality rate ranging from 8% to over 30% depending on the patient’s underlying condition.