OR / Prep · Colorectal Surgery · open
You’re scrubbing into
Hartmann's procedure
Why are we operating?
Resection of the diseased sigmoid with an end colostomy and a closed rectal stump: the operation for the perforated, obstructed or unstable left colon where an anastomosis would be a gamble.
Indication: Perforated diverticulitis with peritonitis, obstructing sigmoid cancer in an unstable patient, and sigmoid volvulus with compromised bowel.
The operation in 4 steps
01Laparotomy and assessment
02Sigmoid resection
03The rectal stump
04End colostomy
Danger zones
Left ureter
In inflammation or bleeding the retroperitoneal planes close up, and the ureter's peristalsis, its one identifying trick, is easy to miss in a hurried field.
Watch it done
Hartmann's procedure explained
Sigmoid resection, rectal stump and end colostomy, and the reversal that may or may not follow.
Source: School of Surgery · Watch on YouTubeDiverticulitis: Hartmann's procedure, or is a washout all you need?
The evidence on laparoscopic lavage versus resection for perforated diverticulitis.
Source: SAGES · Watch on YouTube
Conceptual teaching for learners preparing to observe and assist under supervision, not operative instructions. Five minutes from now you should know why this operation exists, what its shape is, and which structures it is designed not to injure.