Consent: Hartmann’s Procedure - Podcast Version 0:00 / 0:00 1x 0.25x 0.5x 0.75x 1x 1.25x 1.5x 1.75x 2x This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent. Overview of Procedure A Hartmann’s procedure* is a sigmoid colectomy with end colostomy formation. Typically performed as an emergency, the procedure is most commonly formed due to sigmoid perforation (e.g. secondary to diverticulitis) or a sigmoid malignancy causing bowel obstruction. In a Hartmann’s procedure, a descending colon end colostomy is formed and the residual rectal stump is closed. Whilst a Hartmann’s procedure can be performed laparoscopically, they are usually performed via a laparotomy so ensure adequate space to operate and to allow maximum irrigation of any intra-abdominal contamination. *The procedure is named after French surgeon Henri Albert Hartmann, who first described it back in the 1921 (different to the inventor of Hartmann’s solution despite the same name!) By Aimee Rowe, TeachMeSurgery [CC-BY-NC-ND 4.0] Figure 1Illustration demonstrating a Hartmann’s procedure Complications Intra-Operative Complication Description of Complication Potential Ways to Reduce Risk Bleeding Ensure meticulous haemostasis during the procedure Damage to local structures Structures at risk include small bowel and the kidney + bladder + ureter Anaesthetic risks Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications. Forms part of anaesthetic pre-assessment Early Complication Description of Complication Potential Ways to Reduce Risk Pain Pain is often worse in open procedures, compared to laparoscopic Optimal post-operative analgesia, including epidurals or rectus sheath catheters Infection Includes both wound infections and intra-abdominal collections, as well as respiratory or urinary tract infections post-operatively Intravenous antibiotics at induction, minimisation of faecal contamination during procedure, wound irrigation at closure Ileus Minimise contamination and bowel handling, correct any electrolyte abnormalities post-operatively Scarring Use of laparoscopic surgery if possible to result in a smaller scar Re-Operation Any complication may result in the return to theatre in the immediate post-operative period Rectal stump blow-out When the suture or staple line from the rectal stump leaks or completely dehisces Placing a temporary foley catheter into the rectal stump, to decompress the stump in the immediate post-operative period DVT or PE, Myocardial Infarction, Stroke, or Mortality As with any major surgery, whilst these events are uncommon, important to be aware of Adequate pre-optimisation and anaesthetic assessment, peri-operative prophylactic LMWH, high-dependency level care post-operatively Late Complication Description of Complication Potential Ways to Reduce Risk Adhesions Attempt laparoscopic approach if possible, avoid excess tissue disruption Stoma complications Includes stoma retraction, stoma stenosis, or stoma prolapse Incisional hernia or parastomal hernia Ensure fascia is closed tightly, using a small bites technique Inability to restore bowel continuity In the future, it may not be possible to rejoin the bowel together, due to either surgical or patient factors Frequent questions What is a Hartmann's procedure? A Hartmann's procedure is a surgical intervention involving a sigmoid colectomy followed by the formation of an end colostomy. It is primarily performed in emergencies due to conditions such as sigmoid perforation or malignancy leading to bowel obstruction. What are the main complications associated with a Hartmann's procedure? Complications can occur both intra-operatively and post-operatively, including bleeding, damage to surrounding structures, infection, and pain. Awareness and proper management strategies can help mitigate these risks. How can the risk of infection be reduced during a Hartmann's procedure? To minimise the risk of infection, intravenous antibiotics should be administered at the start of the procedure, and efforts should be made to limit faecal contamination and ensure thorough wound irrigation at closure. What potential late complications can arise after a Hartmann's procedure? Late complications may include adhesions, stoma complications such as retraction or stenosis, and the inability to restore bowel continuity in the future. Proper surgical techniques, such as laparoscopic approaches, can help reduce these risks. Why is meticulous haemostasis important during a Hartmann's procedure? Meticulous haemostasis is crucial during a Hartmann's procedure to prevent intra-operative bleeding, which can lead to significant complications. Ensuring proper control of bleeding enhances the overall safety and success of the surgery. Rate This Article