The Hartmann procedure.

In 1923, Hartmann described an operation for cancer of the rectosigmoid area in high-risk patients not amenable to abdominoperineal resection. In the period 1972 to 1984 at the Queen Elizabeth Hospital in Montreal interest in the Hartmann procedure, with resection, end-colostomy and suture closure of the distal colon intraperitoneally, was renewed. The main indication for the procedure was diverticulitis, with cancer second. The author reviews the experience with 64 patients (average age 80 years) who underwent the Hartmann procedure. Obstruction, perforation and abscesses were the commoner indications. The mortality was 17%, but this included several patients who died from 1 to 6 months postoperatively of multiple-organ failure not necessarily related to the operation. A 30-day death rate was 8%. The complication rate was 35%. Restoration of bowel continuity (second stage) was done 2 to 3 months later in 28 cases with no deaths.