Hartmann’s Procedure

Hartmann’s procedure, also called proctosigmoidectomy, is a specific kind of colectomy. A surgeon removes the last part of your colon (sigmoid colon) where it attaches to your rectum. Sometimes, they also remove part of the rectum.

Then, they perform a colostomy. This means they bring the healthy end of your colon through an opening in your belly to create a stoma. The stoma allows poop to leave your body through a colostomy bag attached to your skin instead of coming out of your anus (butthole).

After your colon heals, your healthcare provider will decide whether it’s safe for you to have the procedure reversed. A reversal reconnects your colon to your rectum so you no longer need the colostomy bag and can poop out of your anus again.

Why do I need Hartmann’s procedure?

Hartmann’s procedure is often an emergency operation to remove:

• A blockage: When something backs up your GI tract, it prevents food, fluid, poop and gas from moving through normally.
• Recurrent infection: This is when an infection keeps coming back and damages your colon, like complicated diverticulitis.
• A hole (perforation) in your intestine: This can cause blood loss and allow bacteria from your intestines to get into places they shouldn’t, which can lead to inflammation and sepsis.
• Colorectal cancer: Without treatment, this can cause a blockage, bleeding or a hole in your colon.

When a surgeon removes part of the bowel under these conditions, it may not be safe to reconnect the bowel during the same surgery (commonly referred to as creating an “anastomosis”). The situation can make it too difficult or dangerous because the connection may not heal properly and bowel contents could leak into your belly.

Benefits and risks of Hartmann’s procedure

Hartmann’s procedure preserves the healthy part of your colon and allows your GI tract to function as normally as possible. In critical situations, it’s a faster and safer alternative to reconnecting your colon to your rectum when the intestine is unhealthy.

Hartmann’s procedure is considered relatively safe. But possible complications include:

• Blood clots
• Chest infection (pneumonia)
• Damage to nearby organs
• Hernia
• Internal bleeding
• Leaking colon
• Scarring around your intestines (fibrosis) that can lead to a blockage

How should I prepare for Hartmann’s procedure?

You’ll fast for six to 12 hours before Hartmann’s procedure. This ensures your stomach is empty for surgery. You may also do bowel prep at home to help clear out your colon.

When you go to the hospital, your care team will place an IV to give you fluids and medications. Then, you’ll receive general anesthesia so you’ll be asleep during the surgery.

What happens during Hartmann’s procedure?

If the surgery is laparoscopic or robotic (minimally invasive), your surgeon will make a small cut in your belly and put a tube with a light and camera at the end through it. Then, they’ll make a few more cuts to get to your colon.

If you’re having open surgery, the surgeon will make one large cut in your abdomen.

In either case, your surgeon will:

1. Find the part of the colon that’s unhealthy and needs removal
2. Remove that part of the colon and seal off the end that connects to your rectum
3. Attach the healthy colon to the abdominal wall and make a new opening there, called a stoma
4. Place a colostomy bag outside the stoma
5. Close up the incisions

A minimally invasive Hartmann’s procedure can take up to six hours to complete. An open surgery takes around three hours.

What happens after Hartmann’s procedure?

After surgery, your care team will move you to a recovery room. You’ll spend a few hours there. Once your condition is stable, you’ll move to a hospital room to recover over the next seven to 10 days. For the first three to seven days of your stay, you’ll get fluids, antibiotics and pain medication through an IV.

Your care team will continue to check on your healing. They’ll also show you how to care for your stoma and use a colostomy bag.

You’ll initially be on a clear liquid diet and slowly transition to solid, soft foods.

You’ll be discharged from the hospital when your vital signs (like heart rate and blood pressure) are stable and you’re able to:

• Get up and move around without help
• Eat solid, soft food
• Poop into your colostomy bag
• Change and clean your colostomy bag
• Manage your pain with medications you take by mouth

What are the potential side effects of Hartmann’s procedure?

As you recover from surgery, you may experience these side effects in the short term:

• Ileus: Your bowels may take some time to start working again. Until they do, you’ll get IV fluids and, sometimes, nutrition in the hospital.
• Anal discharge: Even though you’re no longer using your anus, there may still be fluid inside that comes out when you go to the bathroom. Most of it comes out within the first week.
• Sexual dysfunction: Sometimes, surgery around your rectum can injure nerves that are responsible for sexual function. If you’re female, you may have sensitivity or pain during sex. If you’re male, you may have a hard time keeping an erection or ejaculating.

What is the recovery timeline?

It can take four to six weeks to:

• Stop prescription pain medications
• Go from a soft diet to a regular diet
• Return to an exercise routine or labor-intensive job

It can take three to six months to:

• Get used to living with a colostomy bag
• Feel like you’ve physically recovered
• Potentially start discussing reversal surgery with your provider

When can Hartmann’s procedure be reversed?

Your surgeon will check to see if you’re fit for another surgery between six and 12 months after the first procedure. If you’ve healed well and your general health is good, you may be able to have a reversal surgery. This involves attaching your colon to the remaining part of your rectum and closing your stoma so you can poop in the typical way.

When should I call my healthcare provider?

Seek medical attention as soon as possible if you experience:

• Fever
• Lots of blood coming from your stoma
• Nausea and vomiting
• Severe abdominal pain or pain that gets worse
• Intense cramps that last longer than three hours
• A rash or burning sensation on your skin

What is Hartmann’s pouch?

Healthcare providers sometimes refer to the sealed-off part of the rectum and anus as Hartmann’s pouch. It doesn’t have a special purpose, but your provider might talk about it like a body part when they want to watch for infection or disease.