44143 Colectomy, partial; with end colostomy and closure of distal segment (Hartmann type procedure)

Name of the Procedure:

Colectomy, partial; with end colostomy and closure of distal segment (Hartmann type procedure)

Summary

A Hartmann's procedure is a surgical operation where a diseased part of the colon is removed. The healthy end of the colon is brought out through the abdomen to create a colostomy, while the lower segment is closed off. This procedure allows the intestines to heal and is often temporary, pending further surgery for reconnection.

Purpose

The primary aim of a Hartmann procedure is to treat severe colon conditions. This procedure helps alleviate symptoms and complications arising from diseases in the colon. Pharmaceutical intervention alone may be insufficient for conditions requiring this procedure.

Indications

• Colorectal cancer
• Diverticulitis, with or without perforation
• Severe inflammatory bowel diseases, such as Crohn’s disease or ulcerative colitis
• Bowel obstruction
• Traumatic injury to the colon

Preparation

Patients are usually instructed to:

• Fast for at least 8 hours before surgery.
• Undergo bowel preparation with laxatives or enemas to clear the colon.
• Adjust medications per the surgeon's advice, particularly blood thinners or diabetes medications.
• Complete necessary diagnostic tests, such as blood tests, colonoscopy, and imaging studies.

Procedure Description

1. Anesthesia is administered to ensure the patient is asleep and pain-free.
2. An incision is made in the abdomen to access the colon.
3. The diseased segment of the colon is identified and removed.
4. The proximal end of the healthy colon is brought to the surface of the abdomen to form a colostomy.
5. The distal end (rectal stump) is closed off and left inside the abdomen.
6. The abdominal incision is closed, and the colostomy is secured with an ostomy bag.

Tools, such as surgical staplers and sutures, are used. Advanced laparoscopic instruments may also be involved if the procedure is performed minimally invasively.

Duration

The procedure typically takes between 2 to 4 hours.

Setting

The surgery is performed in a hospital’s operating room.

Personnel

• Surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologists

Risks and Complications

• Infection
• Bleeding
• Injury to surrounding organs
• Colostomy issues, such as leakage or blockages
• Temporary or, rarely, permanent change in bowel habits

Benefits

• Relief from symptoms of the underlying condition
• Prevention of life-threatening complications
• Improvement in quality of life Benefits can often be observed soon after recovery, depending on the underlying condition.

Recovery

Post-procedure care includes:

• Hospital stay ranging from 5 to 10 days.
• Pain management with medications.
• Instructions on managing the colostomy.
• Gradual reintroduction of normal activities.
• Follow-up appointments to monitor healing and plan any further interventions.

Alternatives

• Total colectomy
• Segmental resection with primary anastomosis
• Non-surgical treatments such as antibiotics or lifestyle changes, depending on the condition Each alternative has its own set of pros and cons, to be discussed with the healthcare provider.

Patient Experience

During the procedure, the patient will be under general anesthesia and not feel anything. Post-operation, there may be discomfort, especially at the incision and colostomy site. Pain management strategies are applied to ensure comfort. Gradual recovery will follow, with mobility and diet being reintroduced with medical guidance.