Hartmann's

operation

A proctosigmoidectomy,
Hartmann's operation or
Hartmann's procedure is the
surgical resection of the
rectosigmoid colon with closure
of the anorectal stump and
formation of an end colostomy. It
was used to treat colon cancer or
inflammation (proctosigmoiditis,
proctitis, diverticulitis, volvulus,
etc.). Currently, its use is limited to
emergency surgery when
immediate anastomosis is not
possible, or more rarely it is used
palliatively in patients with
colorectal tumours.[1]

Hartmann's operation
Hartmann's operation: A - extended
sigmoid resection (gray); B - rectal
stump closed; C - colostomy.

Other names Hartmann's

procedure

ICD-9-CM 45.75 (http://icd

9cm.chrisendres.

com/index.php?s
rchtype=procs&
srchtext=45.75&
Submit=Search&
action=search)
[edit on Wikidata]
The Hartmann's 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 this procedure, the
lesion is removed, the distal bowel
closed intraperitoneally, and the
proximal bowel diverted with a
stoma.

The indications for this procedure

include:

a. Localized or generalized
 peritonitis caused by
perforation of the bowel
secondary to the cancer
b. Viable but injured proximal
bowel that, in the opinion of the
operating surgeon, precludes
safe anastomosis
c. Complicated diverticulitis[2]

Use of the Hartmann's procedure

initially had a mortality rate of
8.8%.[3] Currently, the overall
mortality rate is lower but varies
greatly depending on indication
for surgery. One study showed no
statistically significant difference
in morbidity or mortality between
laparoscopic versus open
Hartmann procedure.[4]

Etymology and history

The procedure was first described
in 1921 by French surgeon Henri
Albert Hartmann.[5] The original
two-paragraph article in French
together with an English
translation by Thomas Pézier[6]
and a modern commentary is
available.[7] The procedure is
described in detail in his book,
Chirurgie du Rectum, which was
published in 1931 and constituted
volume 8 of his Travaux de
Chirurgie.[8]

References
1. Balanzoni S, Perrucci A, Pasi L,
Montanari M (1997). "The
Hartmann intervention. The
current indications and the
authors' own experience".
Minerva Chir. 52 (4): 383–6.
PMID 9265121 (https://pubme
d.ncbi.nlm.nih.gov/9265121) .
2. Welch JP, Cohen JL, Barczak R.
 Diverticulitis. Ashley SW, Cance
WG, Chen H, et al, eds. ACS
Surgery: Principles & Practice.
Toronto: BC Decker; accessed
April 15, 2010.
www.acssurgery.com:
3. Ronel DN, Hardy MA. Henri
Albert Hartmann: labor and
discipline. Curr Surg. 2002
Jan-Feb. 59(1):59-64.
[Medline].
4. Dis Colon Rectum. 2013
Jan;56(1):72-82. doi:
10.1097/DCR.0b013e3182749
cf5.
5. Hartmann, H.: 30th Congress
 Francais de Chirurgie-Process,
Verheaux, Memoires, et
Discussions, 30:411, 1921
6. http://www.grandroundsjournal.
com/articles/gr089001/hartma
nn-original.pdf
7. Hotouras A (2008). "Henri
Hartmann and his operation" (h
ttp://www.grandroundsjournal.c
om/articles/gr089001/gr0890
01.pdf) (PDF). Grand Rounds.
8: L1–2. doi:10.1102/1470-
5206.2008.9001 (https://doi.o
rg/10.1102%2F1470-5206.200
8.9001) (inactive 31
December 2022).
 8. Ronel D, Hardy M (2002).
"Henri Albert Hartmann: Labor
and discipline". Curr Surg. 59
(1): 59–64. doi:10.1016/S0149-
7944(01)00572-4 (https://doi.
org/10.1016%2FS0149-7944%
2801%2900572-4) .
PMID 16093106 (https://pubm
ed.ncbi.nlm.nih.gov/16093106
) .

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