Hartmann Cirurgia: A Comprehensive Guide to Hartmann's Procedure

Introduction

Hartmann's procedure, also known as Hartmann's operation or Hartmann's pouch, is a surgical intervention used to treat certain conditions involving the colon, rectum, and anus. Named after the German surgeon Henri Albert Hartmann, who first described the procedure in 1921, Hartmann's surgery involves the removal of a diseased segment of the colon, typically the sigmoid colon and rectum, along with the creation of a temporary stoma or diverting ileostomy. The stoma allows for the passage of waste and fecal matter while the remaining colon and rectum heal.

When is Hartmann's Procedure Indicated?

Hartmann's procedure may be recommended as a surgical treatment for a range of conditions, including: - Perforated diverticulitis: When diverticulitis, a condition characterized by inflammation and infection of pouches in the colon, leads to perforation or rupture of the colon - Complicated diverticulitis: In cases where diverticulitis does not respond to conservative treatment or antibiotics, or when complications such as abscesses or fistulas develop - Colorectal cancer: When cancer is located in the sigmoid colon or rectum and requires surgical removal - Ulcerative colitis: A chronic inflammatory condition of the colon that may necessitate the removal of a diseased segment

Procedure Overview

Hartmann's procedure typically involves the following steps: - Laparoscopy or open surgery: The surgeon accesses the abdominal cavity either through laparoscopy (minimally invasive surgery) or open surgery (traditional open incision) - Resection of diseased tissue: The surgeon removes the diseased segment of the colon, along with the rectum if necessary - Creation of a stoma: An opening is created in the abdominal wall, through which the end of the remaining colon (the distal end) is brought out. This stoma allows for the collection of waste in a stoma bag - Closure of the proximal end: The proximal end of the remaining colon, which is connected to the small intestine, is closed off

Post-Operative Care and Recovery

After Hartmann's procedure, patients typically remain in the hospital for a few days to recover. The stoma will require regular care and emptying, typically involving the use of stoma bags and specialized nursing supplies. A healthcare professional will provide instructions on how to properly care for the stoma and manage the ileostomy. The recovery time from Hartmann's surgery can vary depending on the individual patient's condition and overall health. In general, it may take several weeks or months for the remaining colon and rectum to heal. During this time, patients may experience some discomfort or pain, which can be managed with pain medication. Regular follow-up appointments with the surgeon are important to monitor the healing process and adjust the stoma care regimen as needed.

Advantages of Hartmann's Procedure

- Effective treatment for severe diverticulitis, colorectal cancer, and other conditions - Reduces the risk of complications from advanced diverticulitis - Allows for decompression of the colon, reducing pressure and inflammation - Provides temporary diversion of waste, allowing for healing of the remaining colon and rectum

Disadvantages of Hartmann's Procedure

- Requires the creation of a stoma, which can be inconvenient and may impact daily life - May lead to complications such as stoma prolapse, hernia, or blockages - Can result in long-term changes in bowel function and lifestyle - Does not always restore normal bowel function, and a permanent stoma may be required

Alternative Procedures

In some cases, alternative procedures to Hartmann's operation may be considered, such as: - Colectomy: Removal of the entire colon, with or without the rectum - Ileorectal anastomosis: Removal of the diseased segment of colon, followed by reconnection of the small intestine directly to the rectum - Colostomy: Creation of a stoma in the colon, bypassing the rectum The choice of procedure will depend on the specific condition and the patient's overall health.

Conclusion

Hartmann's procedure is a surgical option for treating a range of conditions affecting the colon, rectum, and anus. While it can be effective in addressing severe or complicated cases, it is important to weigh the potential benefits and risks before undergoing the surgery

Hartmann Cirurgia