DEVELOPMENT OF INDICATIONS FOR HARTMANN PROCEDURE, BASED ON A SERIES OF 160 CASES

The authors report the results and indications of 160 Hartmann's procedures performed over a period of 15 years. Between 1978 and 1992, 160 patients (90 males, 70 females), with a mean age of 72, underwent Hartmann's procedure for rectosigmoid carcinoma in 55 % of cases, for complications of sigmoid diverticulitis in 36 % and for other lesions in 14 %. Hartmann's procedure was performed either electively (42 %) or as an emergency (58%) with a mortality of 6 % and 32 % respectively. The majority of complications included wound infections or intraperitoneal abscess, and the overall morbidity was 30 %. Re-establishment of bowel continuity was performed in 30.7 % of patients, most of whom had been initially operated as an emergency for a benign lesion. These 160 cases of Hartmann's procedure represent 27 % of the 590 operations performed during the same period as an emergency or electively for rectosigmoid lesion. Hartmann's procedure remains a most effective technique for emergency surgery for benign or malignant lesions with colonic septic complications, and is also indicated electively for palliative treatment of rectosigmoid carcinoma.