What is Hartmann’s procedure?

Hartmann’s procedure is an operation to remove part of the sigmoid colon and/or rectum. It is most commonly performed for patients with bowel cancer or diverticular disease. This procedure is often carried out in emergency situations, such as when the bowel is blocked, perforated, or if there is a severe infection (abscess) around the bowel.

What does the operation involve?

While this operation can be performed laparoscopically (keyhole surgery), it is often carried out as an open procedure, especially in emergency cases. During the operation:

• The diseased part of the sigmoid colon and/or rectum is removed

• Blood vessels and lymph nodes associated with the affected bowel are also taken out

• If it is not safe to rejoin the bowel due to infection, obstruction, or perforation, the surgeon will create a colostomy by bringing the end of the colon to the surface on the left side of the abdomen

• The remaining rectum is sealed off with sutures or staples and left inside the abdomen. This is known as Hartmann’s procedure

The surgery typically lasts around three hours. The removed bowel segment is sent to the pathology department for examination, with results usually available within two weeks.

What are the risks of the surgery?

As with any abdominal operation, Hartmann’s procedure carries some risks, including:

General risks:

• Blood clots (thrombosis): Patients wear compression stockings and receive blood-thinning injections to minimise the risk

• Bleeding: While rare, a blood transfusion may be required if there is significant blood loss

• Infection: Wound infections can occur but are usually treatable with antibiotics

Specific surgical risks:

• Ileus (delayed bowel function): The bowel may temporarily stop working, causing bloating and vomiting. This is usually managed with bowel rest, intravenous fluids, and sometimes a nasogastric tube

• Bowel obstruction: Adhesions, kinks, or twists in the bowel can cause a blockage. Most cases resolve with bowel rest, but surgery may be necessary in some instances

• Pelvic nerve damage: Important pelvic nerves may be affected during surgery, potentially causing issues with bladder function and, in men, sexual function (erections and ejaculation). This risk is higher for patients who have undergone radiotherapy

Recovery and aftercare

In hospital:

• You will have an intravenous drip for fluids, typically removed within 24 hours

• A catheter (to drain the bladder) is usually in place for 48-72 hours

• An abdominal drain may be used and is typically removed within a few days if necessary

• You will be encouraged to eat and drink as soon as you feel able, usually on the same day

• Early mobilisation is encouraged to aid recovery

• Hospital stay typically lasts 5-7 days for keyhole surgery and 7-10 days for open surgery, though this may vary

At home:

• You should remain mobile but avoid heavy lifting or strenuous activities for about six weeks

• Most patients can resume driving after 4-6 weeks, but this may vary depending on recovery

• A follow-up consultation is scheduled approximately two weeks after discharge, though earlier appointments can be arranged if needed

Colostomy reversal

In many cases, the colostomy can be reversed in a second operation. This procedure involves removing the colostomy and reconnecting the bowel. The surgeon will discuss this with you at your follow-up appointment. Patients are typically advised to wait at least three months after their initial surgery to ensure full recovery before undergoing a reversal.

Why choose the Midlands Bowel Clinic?

• Expert colorectal surgical care with a focus on patient-centred treatment

• Specialists in emergency and elective bowel surgery

• Comprehensive pre-operative and post-operative care tailored to individual patient needs

• Personalised support and guidance for colostomy management and potential reversal

• A dedicated multidisciplinary team providing high-quality care in a professional and comfortable environment

Contact us

If you have any questions about Hartmann’s procedure or would like to arrange a consultation, please contact the Midlands Bowel Clinic. Our friendly team is here to provide support and guidance at every step of your treatment journey.