Hartmann's Operation Research Articles

Sphincter-preserving operations in cases of ulcerative colitis (author's transl)

Eighteen cases of operated ulcerative colitis are described. In 15 cases ileorectal anastomosis was performed. In one case, the rectum had to be excised because of a massive rectal haemorrhage; in another case, the anastomosis had to be separated Hartmann's operation) because of a dehiscence of the anastomosis. A re-examination of 13 patients shows full continence in 12 cases; one patient was incontinent with regard to flatus. The Karnofsky Index shows 100 in 10 patients, and 90 in 3 patients. The sigmoidoscopy reveals normal rectal mucosa in 6 patients, a moderate colitis in 5 patients and a severe colitis in 2 patients. There are only two indications for rectal excision in our opinion: uncontrollable rectal haemorrhage and carcinoma (dysplasia).

Surgical management of diverticulitis.

Veidenheimer, M. C. M.D.1,a; Berman, Irwin M.D.2,b; Castro, Alejandro F. M.D.3,c; Gallagher, Donald M. M.D.4,d; Hale, Harry W. Jr. M.D.5,e; Salvati, Eugene P. M.D.6,f Author Information

Reconstructing Colonic Continuity After the Hartmann Operation

We present our experience in a series of 25 cases involving reconstruction of bowel continuity after the Hartmann operation for perforated diverticulitis. The term "colostomy closure" has been judiciously avoided because in no way are these procedures comparable. Careful timing and restraint are encouraged to allow adequate recovery from the initial disease process and resultant surgery. Some technical aids are mentioned which may assist in limiting morbidity and mortality.

Henri Hartmann and the Hartmann operation.

Reference to the Hartmann for diverticulitis of the sigmoid colon is found with increasing frequency in the current medical literature. In principle, this operation consists of the removal of a segment of colon containing an acutely inflamed area of diverticulitis, with or without perforation or fistula. The end of the proximal colon is brought out as a colostomy. The end of the distal colon is oversewn above the pelvic peritoneum and dropped back into the abdomen. The incision is then closed. Several months later, after reaction to the disease and the operation has subsided, anastomosis of the ends of healthy colon above and below is carried out as the second stage. Proponents of this approach cite a mortality significantly lower than that after primary resection and anastomosis since the suture line made in the absence of acute inflammation is more secure than one made in the presence of peritonitis

Surgical Treatment of Colonic Diverticular Disease

Of the colonic diverticular disease, right side type is a majority in our country, and usually there is no indication for the operation except when accompanied with serious complications. Relapsing right colonic diverticulitis. is usually treated safely by right hemicolectomy. On the other hand., left side type has high incidence of such life-threatening complications as perforation resulting in localized or general peritonitis. This means the patients are apt to be treated as acute abdomen cases. In our experience of this disease, nineteen cases were treated surgically, eleven cases electively, eight cases as emergency.The latter contains five cases of peritonitis caused by sigmoid colon perforation, one case of intestinal obstruction by pericolic abscess, two cases found during the laparatomy begun with the prediagnosis of appendicitis. We performed the elective operation as one stage, including two cases of hemorrhage. Satged operations were performed in the cases of perforation. The first procedures are resection of the whole lesion and colostomy (Hartmann's operation), and the second is anastomosis. For the cases found during appendectomy operation, only dranage is performed at that time and colonic resection is performed secondarily.

Volvulus of the sigmoid colon in Brazil: a report of 230 cases.

Etiologic and physiopathologic aspects of volvulus of the sigmoid colon in Brazil are presented. It is believed that sigmoidal volvulus in Brazil is a frequent complication of megacolon caused by Chagas' disease, differing in some characteristics from volvulus found in other countries. A review of 230 cases treated between 1938 and 1974 in the Surgical Department of Hospital das Clinicas, University of Sao Paulo School of Medicine, is presented. The successive variations used to treat this disease occurred parallel to those introduced in the surgical treatment of uncomplicated megacolon. From the results, the following treatment is recommended: endoscopic emptying in cases without clinical, roentgenographic or endoscopic signs of intestinal ischemia. Laparotomy should be performed when a complicated volvulus is suspected or when it is not possible to empty the loop. When a simple volvulus is found, the loop should be untwisted and the gaseous contents siphoned off by menas of a rectal catheter. When there is necrosis of the colon, the Hartmann operation is recommended. It is important to submit patients to a definitive treatment of the megacolon soon after endoscopic emptying or surgical detorsion of the volvulus, since recurrences following these measures are frequent.

Free malignant cells in relation to recurrence of carcinoma of the colon.

Follow-up observations on patients operated on for carcinoma of the colon at the Illinois Research Hospital during the past several years have revealed an alarmingly high incidence of local recurrence of carcinoma at the suture line after resection and primary end-to-end anastomosis. This led one of us (W. H. C.) 1 to suspect implantation of cancer cells by the suturing procedure at the time of operation. This same fear has been expressed by Goligher and associates, 2 who reported a 10% local recurrence of carcinoma in 162 patients having local resection of the proximal part of the rectum followed by end-to-end anastomosis or colostomy and inversion of the rectal stump (Hartmann operation). In two of their patients carcinoma became imbedded in the soft tissues of the abdominal wall or perineum. These authors studied an additional 7 cases (total of 23) of local recurrence of carcinoma obtained from other hospitals. In