Wednesday, June 12, 2013

Understanding The Hartmann's Procedure

Hartmann's procedure is an operation that involves the removal of part of the large intestines. This procedure is normally used as an emergency measure on patients who do not support extensive surgical operations or where anastomosis is not possible.

What are the indications for a Hartmann Procedure?
Though this procedure was initially developed to address the problem of distal colonic adenocarcionoma, related indications have progressed with time. Some of the common indications addressed through this surgical operation currently include:

~Complicated Diverticulitis
This is one of the most common indications for a Hartmann procedure. It normally occurs at sites of vascular penetration between antimesenteric taeniae and mesenteric taenia. Depending on the magnitude, diverticulitis complications can be categorized into 4 categories namely: parabolic absess, disntant absess, purulent perintonitis and fecal peritonitis. Hartmann procedure is mostly preferred for the treatment of the last two stages.

~Rectosigmoid Cancer
This is the next common indication for a Hartmann procedure. In emergency cases, the predominant Rectosigmoid Cancer symptoms may include perforation and bleeding. On the other hand, in elective cases, palliation is the common symptom. Other rectosigmid cancer related indicators include: Volvulusm ischemia; lymphoma, metastatic cancer; crohn disease; ulcerative colitis; pneumatosis cystoides and retroperitoneal bleeding.

Apart from these two dominant categories, a Hartmann procedure may also be carried out whenever a colon resection is necessary. This is normally done in patients who are malnourished.

What does the operation involve?
A cut is usually made in the tummy. This creates an allowance through which the surgeon removes the affected area of the bowel before making a colostomy. Basically speaking, colostomy is an allowance made at the end of the colon to allow for the passage of fecal waste. In some cases, it is possible to have this allowance reversed in a process called reversal Hartmann's procedure. The wound made after the cut is usually closed with stitches or clips. Any visible clips or stitches are normally removed within 12 days.

What the risk is of involved in this procedure?
Well, Hartmann's procedure is a major operation. As with any other surgical operation, the operation has a fair share of risks involved. Some of the common risks include:

*Nerve damage: This procedure is normally done very close to the anal sphincter (muscles of the back passage). In the process, some muscles may become bruised thus causing damage of the nerves. Occasionally, this can lead to incontinence of feces or wind. In extreme cases, this surgical operation may interfere with the bladder and sexual function although the risks are often temporary.

*Paralysis of the Bowel: Sometimes, this operation may lead to the obstruction of the small bowel (ileus). If this happens, the bowel may need to be rested before an operation is carried out to unblock it.

*Other Risks after the operation
Hartmann's procedure may lead to chest complications, patients are normally advised to avoid smoking and practice deep breathing exercises after this procedure. Apart from chest infections, other complications may include thrombosis, wound infection and blood clot in the lungs.

Benefits of Hartmann's procedure
Through this operation, doctors are able to remove the affected part of the bowel. This provides a good solution to most bowel problems such as colon cancer and divercullitis.

Alternative Procedures
As we learnt in the introductory part of this write-up, this operation is normally performed during emergencies. If incase the problem is still containable, a hollow tube (commonly known as a stent) is usually inserted in the bowel. Once in place, stents help keep the passage open. However, these only relieve the symptoms for a short while.

What to do before the operation
While preparing for the Hartmann's procedure, it is important you prepare yourself physically. Try to eat a balanced diet, perform gentle exercises and get plenty of fresh air. At this point you're strongly advised to stop smoking.

Just to sum it up, it is our sincere hope that you've found this article useful. If in case of related symptoms, do not hesitate to consult a qualified medical doctor for treatment and specialized advice.

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