What if you have a serious infection, blockage, or cancer in your intestines and need major surgery? Sometimes, doctors have to perform a life-saving operation very quickly. One special procedure used in such cases is called the Hartmann's Procedure. The name may sound a little scary, but let's talk clearly and simply about what actually happens, why it's done, and what happens after the surgery.
Simply put, what is this Hartmann procedure?
A Hartmann procedure is a surgery performed on our large intestine (colon). Specifically, it involves cutting out and removing the diseased part of our large intestine, especially the last part where feces exit, which is the sigmoid colon, and sometimes the upper part of the rectum.
Now imagine that after removing the diseased part of the intestine, the two remaining healthy parts need to be reconnected. However, it is very risky to reconnect the two parts at the same time when there is a severe infection, swelling, or other complications. Doing so could cause the infection to spread again, which could be a big problem.
That's why doctors are giving the two remaining parts of the intestine time to heal.
1. The end of the intestine connected to the anus (rectal stump) is temporarily sewn closed.
2. The healthy end of the large intestine, which is at the top, is attached to a small opening (stoma) made in the abdominal wall.
This is where the stool comes out through this new opening in the abdomen. This is called a colostomy . To collect this stool, a special bag (colostomy bag) is attached to the outside of that opening.
This may sound like a big change, but remember, this is often a temporary solution . Once the bowel has healed well (about 6-12 months), another surgery can be performed to reconnect the two parts of the bowel that were blocked, closing the colostomy.
Why do you need this surgery?
There are several main reasons for performing a Hartmann procedure. There are different reasons for removing part of the intestine and for placing a colostomy.
Why is part of the intestine removed?
- Obstruction: If there is a blockage somewhere in the intestine that prevents stool from moving.
- Perforation: If a hole forms in the intestinal wall and stool leaks into the abdominal cavity, this can spread infection throughout the abdominal cavity (peritonitis).
- An uncontrollable infection or disease: Some infections (e.g., complicated diverticulitis) or diseases such as cancer may require removal of the diseased portion to prevent further spread.
Why is a colostomy placed?
As mentioned above, when surgery is performed in an emergency, the patient's body is weakened and the risk of infection is very high. In such a situation, connecting the two parts of the intestine (anastomosis) is very risky. Therefore, the first goal of doctors is to save the patient's life. A colostomy gives the intestine time to heal, and then allows for a more appropriate, less risky, reoperation to restore normalcy.
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How the surgery is performed and the process
This surgery can be done in two main ways:
1. Open Surgery: Surgery is performed by opening the abdominal cavity through a large incision in the abdomen. This method is most often used in emergency and complex cases.
2. Laparoscopic Surgery: Surgery is performed through several small incisions in the abdomen, using a camera and special instruments. Although recovery is faster, this method is not suitable for all patients.
Before surgery
If you are being prepared for surgery, you will be asked to fast for 6-12 hours. You may also be given a special liquid (bowel preparation) to clean out your intestines. After you are admitted to the hospital, a saline cannula will be inserted into a vein in your arm and you will be given fluids and medications.
During surgery
You will be put under general anesthesia for the operation. The surgeon will remove the affected part of the intestine, close the end of the rectum, and attach the other end to the stoma opening in the abdomen. Finally, the colostomy bag will be attached and the surgical wound will be stitched. The entire procedure can take about two to four hours.
After surgery
After the surgery, you will first be taken to the recovery room and then transferred to the ward once your condition stabilizes. You will need to stay in the hospital for about 7-10 days.
- In the early days, painkillers, antibiotics, and fluids will be given through saline.
- It may take several days for the intestines to function again.
- First, they are given liquid food and gradually introduced to solid foods.
- A specially trained nurse will teach you and your family how to clean and change the colostomy bag, and how to care for the stoma (stoma care).
What are the possible risks and side effects?
As with any surgery, there are some risks involved, but it is considered a relatively safe procedure.
- Possible risks: wound infection, lung infection (pneumonia), internal bleeding, intestinal leakage, damage to surrounding organs, hernia formation.
- Possible side effects:
- Temporary ileus: It takes some time for the intestines to start working again after surgery.
- Anal discharge: Even if you are not having a bowel movement, a mucus-like fluid may occasionally come out of the remaining part of the rectum. This is normal.
- Sexual dysfunction: Very rarely, surgery can damage the nerves involved in sexual function. Talk to your doctor if you have any concerns about this.
Recovery and recovery
It takes some time to fully recover.
- Weeks 4-6: Reduce pain medication use, return to a normal diet, and resume light exercise.
- 3-6 months: Getting used to life with a colostomy bag, feeling fully recovered physically.
Can a colostomy be reversed? (Reversal)
This is the biggest problem for many people. Yes, in most cases it can be reversed.
About 6-12 months after your first surgery, your surgeon will reevaluate your health. If you are in good health, your bowel has healed well, and you are able to tolerate another surgery, you may choose to have reversal surgery .
However, if the cancer has spread throughout the body, if there is severe systemic disease, or if the patient is very weak, the doctor may not recommend a second surgery. You can talk openly with your doctor about all of these things.
Take-Home Message
- The Hartmann procedure is a very important life-saving surgery, often performed in an emergency.
- This surgery involves creating a temporary opening in the abdomen for stool to pass through. This is called a colostomy , and you will have to learn to live with it.
- For most patients, this colostomy is temporary and can be restored with another surgery after 6-12 months.
- The healing process takes time. You and your family will need support to adjust to this change, both physically and mentally.
- It is very important to talk openly with your doctor about any questions or fears you have.
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