Hartmann's procedure. Its use with complicated carcinomas of sigmoid colon and rectum

S. G. ReMine and R. R. Dozois

We assessed the safety of Hartmann's procedure in terms of postoperative morbidity and mortality associated not only with the original operation, but also with reestablishment of colorectal continuity and long-term survival. We studied 107 consecutive patients in whom Hartann's procedure was performed either electively (96) or as an emergency (11) between 1970 and 1975. In 87, the resection extended below the peritoneal reflection. The mean age of the patients was 67 years. The principal indication for Hartmann's procedure was palliation (53%), obstruction (42%) either alone or with perforation, and technical difficulties (5%). Four patients died (3.7%) in the immediate postoperative period, two after elective surgery (2.1%). Complications were observed in 35 patients, including wound infection or dehiscence (22), urinary tract problems (seven), and pelvic abscess (three). Colorectal continuity was reestablished in ten patients without mortality or morbidity. The mean five-year survival for Dukes' B, C, and D lesions was 54%, 23%, and 3%. Hartmann's procedure, when performed for complicated carcinomas of sigmoid colon and rectum, including subsequent restoration of bowel continuity, is safe and can be associated with long-term survival.