Operation Hartmann: description, stages, technique

Operation Hartmann is conducted as a method of treatment of colon cancer. In most cases, it is the surgical method of treating the disease that is not only the most effective, but the only one, since chemotherapy for cancer that progresses precisely on this site does not give proper results.

Indication for the operation

An operation of the Hartmann type is indicated for carrying out to weakened and elderly patients diagnosed with "Sigmoid colon cancer or rectosigmoid section". There are other reasons why a doctor can prescribe a Hartmann operation:

• Complicated obstruction of the named areas (in most cases food does not move through the intestine at all);
• Perforation (through intestinal disturbance);
• The turn of the sigmoid colon in case of complication of gangrene or peritonitis (lengthening of the bowel, deformation of its mesentery).

It is performed, as a rule, for emergency indications, for example, with the manifestation of tumor disintegration or intestinal obstruction.

Operation Hartmann: stages

Most patients are only the first stage. The next stage with a favorable recovery period is carried out only after six months.

Operation Hartmann, a description which provided B. Petrov, is divided into two stages. Used to treat the descending and transverse colon of the intestine.

So, the whole operation consists of the following stages:

1. This stage was described by Petrov BA, who gave him the name "obstructive resection". Very often patients with a diagnosis of "cancer" spend only this procedure. It consists in the removal of a specific area of the intestine, on which the tumor is located. After this, the lumen of the distal segment is stitched. This is done tightly, and the lumen itself is left in the abdominal cavity. The proximal end of the operated intestine is removed by the surgeon on the abdominal wall from the front part. This conclusion is called a colost, which will be described in more detail below.
2. The second stage with a favorable period of rehabilitation is carried out not earlier than two months, in some cases even after six months. It consists in restoring the continuum of the colon with an anastomosis end-to-end. The colostomy is removed. A variant of anastomosis is possible side by side, however in most cases surgeons reject it.

Preparation of the patient for surgery

First of all, the procedure of preparation of the patient for its implementation is carried out. Since it usually makes the patient weak, depleted, it is necessary to conduct a series of examinations, as well as general strengthening treatment, so that the person can be transferred to the operation without a fatal outcome. Used for this facility, the action is aimed at activating cardiac activity, regulating the work of the gastrointestinal tract, possibly, blood transfusion, as well as the appointment of a large number of vitamins and a special diet.

Operation Hartmann: technique

For the operation, the patient is placed on his back. The abdominal cavity is opened by the lower midline incision from the pubis and by 5 cm (sometimes slightly less) than the navel. After this, the patient is transferred to the Trendelenburg position (the head and shoulder girdle of the patient are located below the pelvic area). Next is the so-called mobilization of the sigmoid colon, for this purpose a towel is usually used. At the root of the mesentery, as well as under the peritoneum of the Douglas pocket, a certain amount of novocaine (about 250 ml) is usually administered. Now the revision is being carried out and the localization of the tumor and its other characteristics are being specified. The sigmoid colon, on which the operation is performed, should be taken to the wound and taken to the right side closer to the midline. The mesentery is stretched. Next in the course are scissors, which dissect the outer leaf of the peritoneum. It is carried out in the place where the root of the mesentery is located. The dissection is carried out along the entire length of the loop, which will subsequently be removed. After this, the intestine is removed to the outside, and the inner peritoneal sheet is cut. The second and third arteries intersect in a place that was previously placed between the clamps. This place is characterized by a departure from the lower artery of the mesentery. Then it is bandaged with a silk thread. The surgeon carefully monitors that the left artery is preserved, if possible, the doctor also retains the upper and rectal arteries.

The mesentery is also clamped from two sides and intersected between the instruments, after which the vessels passing inside it are further bandaged.

In case there is a removal of the upper ampullar department, the artery of the rectum, which is located at the very top, is necessarily bound up.

Clips are applied in the following places:

• Above the affected area of the intestine;
• Supramarginal segment of rectum.

Between these clamps, the affected bowel is removed with an acute scalpel. This occurs within healthy areas. The end of the intestine is tightly sutured. Used for this are catgut and silk threads.

Postoperative period

During this period, the following actions are performed:

• Through a special tube three times a day the bowel is washed. Used for this weak solution of antiseptics, the appointment of which the doctor makes a decision based on the analysis.
• Entering antibiotics for five days.
• A special diet is prescribed, during which you can take exclusively liquid food.
• The doctor prescribes taking medications that help delay the stool.

Tubes for lavage of the intestine are removed after 7-9 days immediately after the operation.

After 3-6 months of the postoperative period, under the condition of its favorable course, restoration of intestinal continuity, as well as removal of unnatural anus can be carried out.

Possible complications after surgery

The main complication, which can be very dangerous for the health of the patient, is bleeding. It can manifest itself both during the operation and after it.

After surgery, there may be a shock, which also threatens the patient's life. The statistics state that most often the operated ones die within one or two days after the operation.

The most common complication is the penetration of infection into the wounds. To avoid this, careful preparation of the intestine for the operation is required in order to relieve the patient from the need to defecate in the first days of the postoperative period. If, however, because of the narrowing of the intestine, it is not possible to remove its contents, then the operation takes place in two stages, which were described in the first half of the article.

Procedures after surgery

During the rehabilitation, there may be a delay in urine, and complaints from patients are usually not received. Urine is excreted artificially, and it occurs only 10 hours after the operation is completed. The procedure is carried out at least three times a day. Ignoring this can lead to the fact that the bladder is simply stretched, it will be thrown backwards and, naturally, will lose its ability to contract.

Instead of concluding

The effectiveness of the operation affects a number of factors, in particular, the patient's condition before the operation, the timing of surgical intervention, the choice of the correct method of conducting the operation. But despite this, in many cases, Hartmann's operation on the large intestine can be the only method of treatment.