A critical evaluation of the Hartmann's procedure.

We reviewed 150 cases of Hartmann's procedure between 1972-86. Indications, rate of colostomy closure, and "diversion colitis" of the rectal pouch are discussed. There were 76 cases performed for diverticulitis. This procedure is easy to perform and carries a low risk. While it removes the diseased bowel segment, it leaves the patient with a colostomy requiring a major operation for closure. When possible, resection with anastomosis is preferable. There are no generally accepted guidelines for performing the Hartmann procedure; it depends on the individual surgeon. Forty three cases were performed for carcinoma. For palliation, it is a good operation; for cure others are preferable. With few exceptions, it is a poor choice for inflammatory bowel disease. In 42 cases of diverticulitis, the colostomy was not closed because of the patient's age, medical or surgical contraindications. Thirteen patients declined the closure. Twelve pouches had to be removed. Mild colitis was found in every pouch examined endoscopically. Severe colitis was found in one patient operated for cancer, in three for diverticulitis, and in 11 for colitis.