What is Hartmann's Procedure? Don't worry, let's talk about it simply.

Has your doctor told you or someone in your family that you need to have a procedure called a "Hartmann's Procedure"? You may have felt a little scared when you heard that name. It's very common. But this is a very important surgery that is done to save lives. So today, let's talk about it very simply, in a way that will remove all the questions and fears you may have about it.

Simply put, what is Hartmann's Procedure?

Think of our digestive system as a long tube. The end of this tube is what we call the colon. In a Hartmann procedure, the diseased and damaged end of the colon (called the sigmoid colon) and sometimes part of the rectum, where stool is stored, are removed.

Simply put, this is a surgery that removes part of the large intestine (colectomy). However, the specialty is that after a section is removed, the two remaining parts of the intestine are not immediately reconnected.

Instead, the surgeon does something like this:

1. The end of the intestine connected to the rectum is sewn closed.

2. The healthy part of your colon that comes out from the top is connected to a small opening (called a stoma) made in the skin of your abdomen.

Then, a colostomy bag is placed outside this opening. Your stool will then pass out of your body into this bag. While this may sound like a big change, it is usually temporary. After your bowel has healed, about 6 to 12 months later, another surgery can be performed to remove the bag and reconnect the two parts of your bowel.

Why is it necessary to have this kind of surgery?

There are two main reasons for performing a Hartmann procedure. One is to remove part of the intestine. The other is to place a colostomy bag. Let's look at the reasons for each of these.

Why is part of the intestine cut out and removed?

A person may need to have part of their colon removed for the following reasons:

• Intestinal obstruction: If a part of the intestine is completely blocked due to a tumor, cancer, or other cause, that part will have to be removed.
• Intestinal Perforation: If an infection or accident causes a hole in the intestine, causing stool to leak into the abdominal cavity, it is life-threatening. Therefore, the damaged part must be removed immediately.
• An uncontrollable infection or disease: To stop the spread of some infections (for example, severe diverticulitis) or diseases like cancer, the diseased part must be completely removed.

Why is a colostomy bag placed?

Removing a section of the intestine and reconnecting the remaining two sections in the same surgery is called a "primary anastomosis." However, to do this, the patient's condition must be very good, and there must be no risk of infection.

But Hartmann's surgery is often performed in an emergency. That is, when the patient has a severe infection or swelling inside the abdominal cavity. In such a dangerous situation, if the two parts of the intestine are connected, the stitches may not heal properly, and the stool may leak again, making the situation even worse.

What are the main reasons for performing Hartmann surgery?

There are several medical conditions that often require this surgery.

How is the surgery performed?

Hartmann's surgery can be performed in two ways.

1. Open Surgery: In this, the surgery is performed by making a slightly larger incision in the abdomen and opening the abdominal cavity.

2. Laparoscopic Surgery: This is also called "keyhole surgery." The surgery is performed through a few small incisions in the abdomen, through which a camera (laparoscope) and special instruments are inserted. This method leaves less scarring and has a shorter recovery time.

However, depending on the severity of your condition, you may start with a laparoscopic approach and then switch to open surgery during the procedure. This will be decided by your surgeon.

What happens before the surgery?

• You will be asked to stop eating and drinking 6-12 hours before the surgery.
• Depending on your condition, you may be given a special drink to cleanse your intestines.
• When you are admitted to the hospital, an IV catheter is inserted into a vein in your arm.
• The doctor will explain the painkillers to you in advance.

What happens during the surgery?

You will be given general anesthesia, so you will not feel anything. The surgery can take about two to four hours. The surgeon will remove the diseased part of the intestine, create a colostomy as we discussed earlier, and sew up the incisions.

What to expect after surgery?

After surgery, you will first be taken to a recovery room. Once your condition is stable, you will be transferred to a ward.

• Hospital stay: Usually, you will have to stay in the hospital for about 7-10 days.
• Food: Only liquid food is given in the early days. Gradually, they are introduced to regular food.
• Pain: Intravenous painkillers are given for the first few days, then switched to tablets.
• Bowel function: It may take a few days for the bowels to start working again after surgery.
• Colostomy Bag: A specially trained nurse (stoma nurse) will show you how to use, clean, and change it. Don't worry, it will take some time to get used to.

When can I go home?

• When things like your heart rate and blood pressure return to normal.
• When you can get up and walk without anyone's help.
• When stool starts to leak into the colostomy bag.
• When the pain can be controlled with pills.
• When you can change the colostomy bag yourself.

What are the possible risks and side effects?

As with any surgery, there are risks involved, and it's important to discuss these with your doctor.

• Possible complications: Wound infection, pneumonia, internal bleeding, blood clots, hernia formation, etc.
• Side effects:
• Temporary intestinal dysfunction (Ileus): After surgery, it may be delayed for the intestines to function. For those days, nutrition is provided through saline.
• Rectal discharge: Even if stool is not coming out, a mucus-like fluid may occasionally come out from the remaining part of the rectum.
• Effects on sexual function: Very rarely, damage to the nerves in the area of ​​surgery may cause changes in sexual sensitivity or function. If you have any concerns about this, talk to your doctor openly.

Can the colostomy bag be removed again? (Reversal Surgery)

This is the biggest problem that many people have. Yes, many people can get this back to normal.

Between 6 and 12 months after the Hartmann procedure, your doctor will reevaluate your health. If you are recovering well and have no other serious medical conditions, another surgery may be performed to remove the colostomy bag and reconnect the two parts of your intestine.

However, some people may not be able to have this second surgery. For example:

• If the cancer has spread to other parts of the body.
• If you have other serious illnesses such as heart disease or lung disease.
• If you cannot afford another surgery due to age or extreme obesity.

Your surgeon is the best person to make this decision.