Closure of Hartmann's Colostomy: A Simple Method for Identifying the Rectal Stump

  • B. A. Salami
  • A. O. Tade
  • B. A. Ayoade
  • C. C. Nwokoro
  • O. M. Fatungase
Keywords: Colostomy, Harrtmann's procedure, Hartmann's reversal, rectal stump

Abstract

Background:  Restoration of intestinal continuity after Hartmann’s colostomy can be very difficult especially in patients with short rectal stumps that are retracted and buried deep in the pelvis.

Objective: To demonstrate a simple method of overcoming the difficulty in the reversal of Hartmann’s colostomy.

Method: A retrospective descriptive study of cases of Hartmann’s colostomy reversal was done.

Results: The technique was used in the reversal of 9 Hartmann’s colostomies carried out over a period of 16 years between 1995 and 2010.  The patients comprised five males and four females. The diagnoses in the males were four cases of sigmoid volvulus, and one gunshot injury. The diagnoses in the four females included sigmoid volvulus, carcinoma of the colon, stricture from endometriosis and gangrenous sigmoid colon from criminal abortion. The mean time for restoration of intestinal continuity after the primary procedure was 7.8 months. Two patients had postoperative wound infection. There was no mortality.

Conclusion: The simple technique was found to be helpful especially in situations where other instruments that facilitate the restorative process are not available

Author Biography

B. A. Salami
Department of Surgery,
Olabisi Onabanjo University Teaching Hospital,
Sagamu, Ogun State

References

Ronel DN, Hardy MA. Henri Albert Hartmann: labour and discipline. Curr Surg 2000; 59(1): 59-64.

Makarawo TP, Eichenauer S, Shah U, Jaeger A, McKendrick A, Mittal VK. Surgery for diverticulitis: a re-evaluation of the changing trends. Int Surg 2014; 99(4): 364-70.

Tade AO. Chronic intestinal obstruction due to rectosigmoid endometriosis: a case report. Niger J Med 2006;15(2): 165-6.

Park JM, Chi KC. Laparoscopic reversal of Hartmann’s procedure. J Korean Surg Soc 2012; 82(4): 256-60.

Antolovic D, Reissfelder C, Ozkan T, Galindo L, Buchler MW, Koch M et al. Restoration of intestinal continuity after Hartmann’s procedure- not a benign operation. Are there predictors for morbidity? Langenbecks Arch Surg 2011; 396(7): 989- 96.

Caracciolo F, Castrucci G, Castiglioni GC. Anastomosis with EEA stapler following Hartmann’s procedure. Dis Col Rectum1986; 29(1): 67-8

Rushden RO, Kusminsky R. Closure of Hartmann’s procedure: a technical note. Am Surg 1982; 48 (10); 528.

Svenningsen PO, Bulut O, Jess P. Laparoscopic reversal of Hartmann’s procedure. Dan Med Bull 2010; 57(6): 1-3.

Macpherson SC, Hansell DT, Porteus C. Laparoscopic assisted reversal of Hartmann’s procedure: a simplified technique and audit of 12 cases. Laparoendosc Surg 1996; 6(5): 305-10.

Sosa JL, Sleeman D, Puente I, Mckenney MG, Hartmann R. Laparoscope assisted colostomy closure after Hartmann’s procedure. Dis Col Rectum 1994; 32(2): 149-52.

Viamonte M, McCarthy B. New technique for Hartmann’s reconstruction. Dis Colon Rectum 1991; 34(2): 1141-43.

Roe AM, Prabhu S, Ali A, Brown C, Brodribb AJ. Reversal of Hartmann’s procedure: timing and operative technique. Br J Surg 1991; 78(10): 1167-70.

Bielecki K, Kaminski P. Hartmann procedure: place in surgery and what after? Int J Colorectal Dis 1995; 10(1): 49-52.

Tan WS, Lim JF, Tang CL, Eu KW. Reversal of Hartmann’s procedure: experience in an Asian population. Singapore Med J 2012; 53(1): 26-51.

Vemeu J, Gosselink MP, Busschback JJ, Lange JF. Avoiding or reversing Hartmann’s procedure improves quality of life after perforated diverticulitis. J Gastrointest Surg 2010; 14: 651-57.

Constantinides VA, Heriot A, Renizi F, Darzi A, Senapati A, Fazio VW et al. Operative strategies for diverticular peritonitis- A decision analysis between primary resection and anastomosis versus Hartmann’s procedure. Ann Surg 2007; 245: 94-103.

Tanase I, Paun S, Stoica B, Negoi I, Gaspar B, Beuran M. Epidemiology of diverticular disease – Systemic review of literature. Chirurgia 2015; 110(1): 9-14.

Alatise OI, Arigbabu AO, Agbakwuru EA, Lawal OO, Ndububa A. Spectrum of colonoscopy findings in Ile-Ife Nigeria. Niger Postgrad Med J 2012; 19(4): 219-24.

Tade AO, Salami BA, Ayoade BA. Observations on early and late colostomy closure. Niger Postgrad Med J 2011; 18(2): 118-20.

Published
2016-03-24
Section
Articles

Most read articles by the same author(s)