Laparoscopic Hartmann’s Procedure

Abstract

AbstractHartmann’s procedure, Hartmann’s resection, or Hartmann’s operation is the surgical resection consisting of sigmoidectomy without intestinal restoration. It contains an end-colostomy and closure of a rectal stump. It was first described by Henri Albert Hartmann (1860–1952) for resection of rectal or sigmoid cancer [1]. Nowadays, Hartmann procedure is usually used in treating malignant obstruction of left-sided colon or in emergent conditions, such as sigmoid colon perforation [2], mostly because of diverticulum disease. The advantage of Hartmann’s procedure is reduction in morbidity and mortality in emergent settings because it avoids the possibility of complications from a colorectal anastomosis. For patients with unstable hemodynamic status, or multiple comorbidity or inflammatory condition of the intestinal tissue, which would make performing a colorectal anastomosis difficult or have a higher risk of anastomotic leakage, this procedure is simple and fast, and meanwhile preserve the chance of restoration of intestine continuity after patients’ general condition got improvement. However, the Hartmann reversal rate is variable in different studies, ranging from 0 to 50% [3, 4]. The morbidity rate of Hartmann reversal is up to 55%, and the mortality rate is ranging from 0 to 14% [5–7]. A study showed reversal of Hartmann between 3 and 9 months associated with increased risk of postoperative complications [8]. The mean interval from Hartmann procedure to its reversal is ranging from 7.5 to 9.1 months [3, 5]. We usually delay the reversal of Hartmann’s operation at least 6 months later in our daily practice. Hartmann’s procedure and/or reversal of Hartmann’s procedure could be conventional or laparoscopic. Laparoscopic reversal of Hartmann’s procedure is associated with less complications compared to the conventional method, especially in wound infection, anastomotic leakage, and cardiopulmonary complications [3].