Hartmann’s Procedure
Patient Information
Colorectal Department
Surgical Nurse Specialist Department
Incorporating hospital and community health services, teaching and research
Introduction
This leaflet explains about the procedure known as a
Hartmann’s Procedure.
Before your operation
Before your operation you may have scans and xrays to assess the extent of the cancer. While
waiting for your operation it is important to prepare
yourself physically. If you can, continue eating a
normal diet and take gentle exercise. If you smoke,
try and stop before your operation
Before the operation you will be asked to sign a
consent form to say that you understand what the
operation involves.
Pre-admission clinic
You may have to attend the pre-admission clinic
where routine pre-operative tests take place e.g.
blood tests, chest x-ray, ECG (electrocardiograph –
trace of your heart); listening to your chest and
checking your blood pressure. This is to make sure
your admission to hospital is as smooth as possible.
During this appointment you may see the nurse
specialist who will be able to answer any of your
questions.
Your admission to hospital
Your bowel may need to be clear before your
operation. You may be given some medicine to clear
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your bowel and encouraged to drink clear fluids only
for one day before your operation. This will help to
clean your bowel and reduce the risk of dehydration
before the surgery.
You will be given: 2 x Bisacodyl tablets and 2 x Picolax sachets
(powerful laxative drink) – to be taken the day
before the operation. Please read the
instruction leaflet you have been given
carefully on how to take the bowel
preparation.
 It is important to drink plenty of fluids while
taking the laxatives to prevent dehydration.
Fluids allowed include water, squash or
tea/coffee (without milk)
 You may continue to drink plain water (not
fizzy) for up to 2 hours before surgery.
If you have been given Energy Drinks (Nutricia PreOp), drink them as soon as you wake up on the day
of surgery before you come to the hospital.
Do not eat any food for 6 hours before you come
to the hospital for your surgery.
Do not take your medications on the day of surgery.
Bring all your medication with you to the hospital and
the Doctors or nurses will advise you which
medications to take.
Your operation details
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Anatomy of the bowel
http://www.bowel-control.co.uk/anatomy/index.htm
Hartmann’s Procedure
This operation involves the removal of the lower part
of the large bowel.
The affected area will be removed including the
sigmoid colon and part of the rectum. With this type
of operation you will usually need a colostomy
(stoma). This will mean that the faeces (stool) will
collect into a colostomy bag attached to the
abdominal wall. A cut will be made in your abdomen
to create the opening.
The waste matter from your body will now pass
through this instead of your bottom.
Depending on the reason for your operation the
colostomy may be temporary to allow the bowel to
rest and heal or permanent in certain cases.
The sigmoid colon is mainly for the storage of waste
matter, thus removing this part has little effect on
your bowel function, although it may be a little softer
and you may find that you open your bowels more
frequently than before.
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Your consultant surgeon and colorectal nurse will
help you understand the procedure involved before
your operation.
The upper part is brought out through the abdomen
wall normally on the right hand side to the surface
this is called a Colostomy.
The operation time may vary for this type of surgery
but is usually around 3 hours.
The piece of bowel that is removed is sent to the
pathology department for examination. The results
are usually available within two weeks of the
operation.
Diagram showing Hartmann’s Procedure
myhealthyfeeling.com
Having a stoma
What is a stoma?
Before your operation the stoma nurse or colorectal
nurse will mark a place on your abdomen where the
stoma will be placed. They will try to make sure that
it is positioned in the best place for you so it does not
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interfere with the clothes you wear and to make it as
discreet as possible.
The stoma care nurse will spend time with you
before your operation discussing your concerns or
questions. You will be given information booklets and
shown appliances (Bags).
A stoma is an artificial opening through the wall of
the abdomen (tummy) to collect waste (stool) into a
bag. A bag fits over this to collect your stool and is
completely disposable. The bag will need to be
changed on a daily basis.
The stoma is part of the bowel and is very pink and
moist, just like the inside of your mouth. At the
beginning it will be quite swollen, but it will shrink
down in a few weeks to about the size of a 50 pence
piece (although this can vary depending on the type
of surgery you have had).
The design of stoma bags has improved in recent
years and they are now completely disposable and
very discrete. They come in various sizes to fit in
with your lifestyle; your stoma nurse will show you a
selection.
Smaller bags can be worn under
swimwear and are unnoticeable. You do not need to
change the type of clothes you wear, although the
stoma care nurse will be able to advise you on
certain clothes that can even further disguise the fact
you have a stoma bag.
There is no reason to change your lifestyle because
you have a stoma. You can still work, travel, eat out
and enjoy a good social life.
Laparoscopically assisted surgery
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If possible your surgery may be performed using a
laparoscopic assisted approach. Laparoscopic
colorectal surgery also known as ‘keyhole surgery’
involves
inserting
laparoscopic
(‘keyhole’)
instruments through a number of small incisions in
the abdomen (tummy).The instrument has a camera
attached which projects images on a TV monitor to
help with the dissection, removal of the diseased
portion and thereby performing the entire surgery
through a slightly larger incision.
The main aim of having this type of surgery is to:
- Reduce hospital stay, minimise hospital
infection
- Quicker recovery
- Minimise scarring
- Reduce discomfort following surgery
Choosing not to have this operation will depend on
your diagnosis following investigations but will
include the continuation and worsening of the
symptoms. The bowel is likely to become obstructed
leading to emergency hospital admission and
possible emergency surgery.
Risks or complications of surgery
Most operations are successful. However, every
procedure has risks and potential complications.
Those that are most relevant to the operation you
are to have are listed below. If there is anything you
are unsure about you can discuss this with your
Doctor or Nurse.
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If you are elderly or have a lot of other serious
medical conditions, we have a specific complex preoperative assessment service. Where you will see a
specialist doctor, cardiologist, Intensive care doctors
and specialist allied health care professionals who
work together to assess and plan your care if you
have an operation.
The risks and complications can be divided into three
areas:1.
Complications of the anaesthesia
2.
General complications of any surgery
3.
Specific complications of this operation
1. Complications of the anaesthesia
Your anaesthetist will talk to you about the risks of
an anaesthetic.
2. General complications of any operation
Pain – this can occur with any operation. You
will be visited regularly post operatively by the
pain team who can regulate the pain relief to fit
your personal needs.
Bleeding – this can occur during or after the
surgery. If this happens you may need a blood
transfusion or very occasionally another
operation may be required. If you have any
religious or personal objection to having a blood
transfusion there are alternatives which will be
discussed with you.
Infection in the surgical wound – this would
usually be treated with antibiotics or occasionally
further surgery (risk: 3-7 in 100).
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Unsightly scarring - this is more likely if the
wound has become infected.
A hernia – this can occur in the incision scar
when the deep muscles fail to heal or around the
site of the stoma. If the hernia appears as a bulge
around the incision line it is called an incisional
hernia, if it occurs as a bulge around the stoma it
is called a parastomal hernia. If this causes
problems, you may need another operation.
Blood clots – These can occur in the legs
(thrombosis) and can move to the lungs to cause
breathing problems. You will be asked to wear
anti-thrombosis tights (long socks) and will be
given injections to reduce the risk. This is the
same thing that can occur during a long airplane
flight (economy flight syndrome).
Difficulty passing urine – You will have a
catheter inserted at the time of the operation
which will remain in place for approximately 7
days.
Occasionally, when the catheter is
removed, you may have difficulty passing urine.
This is more common in men and/or if you have
had difficulties passing urine prior to the
operation.
Chest infection – the physiotherapist will give
you deep breathing exercises to help prevent a
chest infection.
3. Specific complications of this operation
(Hartmann’s Procedure)
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Adhesions – this is where scars form inside the
abdomen.
This can occur following any
operation on the abdomen and does not usually
cause any problems.
However, it can
sometimes lead to bowel obstruction many years
later.
Sexual disturbance – the nerves that supply the
sexual organs in both men and women run very
close to the rectum.
When the cancer is
removed these nerves can be damaged which
may lead to impotence in men and vaginal
dryness in women. Impotence following rectal
cancer surgery is one of the licensed indications
for receiving Viagra (a drug used to overcome
impotence).
Before your operation the surgeon will visit you to
discuss the operation and you will be asked to sign a
consent form. It is important that you fully understand
what operation is planned and what the likely
benefits and possible side effects are.
After your surgery
Following surgery you will go back to the ward. The
nurse on the ward will carry out regular observations
on you. You will be allowed to drink fluids freely and
to eat when you feel able.
When you wake up you will find that you are
attached to several tubes. These may be:  A drip in your arm or neck, which gives
you the extra fluids that you require.
 A
PCA System (patient controlled
analgesia), which is another tube in the
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

arm that gives you a painkiller; you will be
able to control the amount of painkiller you
have by pressing a button connected to a
pump. Painkiller can also be given as an
epidural infusion via a drip in the middle of
your back. The anaesthetist will discuss
these options with you.
A catheter (tube), which goes into your
bladder to drain urine away. This is so the
amount of urine you pass can be
accurately measured.
You may have a drain which is a small
tube which clears away any oozing fluid
around the operation site.
These tubes are put in while you are under
anaesthetic, (except the epidural), and will be
removed within the first 1-3 days after the operation.
You will be in hospital for 4-6 days.
After surgery, you can eat and drink as normal. To
speed up your recovery, you will be given 3
supplements drinks each day. These will be given for
3 days after your surgery.
Managing after surgery
You can eat and drink soon after your surgery. If the
bowel function is slow to start food and drink may be
restricted for a few days.
To speed up your recovery, you will be given 3
supplements drinks each day. These will be given for
3 days after your surgery.
It is important to try and move around soon after the
operation. Becoming mobile will help you to recover
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quickly from the operation and also reduce the risk of
complications.
You will be helped to sit out of bed on the first day
after your surgery and by the 3rd day, you will be
helped to walk around the ward. The physiotherapist
will help you to walk up and down stairs if you have
them at home.
The Stoma Nurse Specialist will start teaching you to
look after this on the 1st day after surgery until you
are able to manage this yourself. This usually takes
3-4 days. She will give you support during your
recovery on the ward, and also once you are at
home.
After the operation, rest is very important as part of
the recovery process, so it is advisable to restrict the
number of visitors coming to see you so you don’t
get overtired.
Visiting time is between 11.00am – 12.30pm and
4.00 – 8.00pm. Only 2 visitors are allowed at a time.
Going Home
The medical staff will be able to advise you if some
movements are restricted, like kneeling or bending
down. This may last for a short period of time, as you
get better you will be able to resume your daily
activities.
The stoma care CNS will arrange your supplies for
home; they will visit you within the first week of
discharge home. If you need any additional help the
district nurse will be asked to visit.
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For the first week or so you will feel tired and weak
when you get home. It is therefore important that
you rest although it is not good for you to stay in bed
all the time. You should try gentle exercise first like
walking around the house or to the end of the street.
Your appetite may be reduced so try eating little and
often to begin with.
For most people it will take 6-8 weeks to recover
from this type of operation. You may feel some pain
and ‘twinges’ around your wound for several months.
This is normal as it takes a while for full healing to
take place. Taking a mild painkiller will help you feel
better and help with recovery.
For the first six weeks you are advised not to lift
anything heavy such as shopping or wet washing,
and not to do anything strenuous like digging the
garden or mowing the lawn.
You should not drive until you can do an emergency
stop without hesitation that your wound will hurt. To
test if you could do an emergency stop, lift both feet
off the ground at the same time. If it does not cause
you abdominal pain you would be able to do an
emergency stop. It is advisable to check your car
insurance for any clauses regarding driving after an
operation.
When you get home you may find that your bowel
habit is still unpredictable. When you have had
some of your large bowel removed you may find your
stools are slightly loose, over time this will resolve
itself. You may also find that you need to change or
empty the stoma bag frequently. This could be
anywhere between 1-4 times per day. If your bowel
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habit does not settle, there are medications that can
help
.
You may also get the feeling you need to open your
bowels from your back passage, or you may pass
some mucous, this is normal after the operation. If
you are worried please discuss it with the stoma care
nurse or your doctor.
The length of time before you are fit to return to work
will be individual and dependent on the type of work
you do.
Once you have recovered from your operation there
is no reason why you can’t go back to your normal
sex life. However, operations on the rectum can
cause damage to the nerves that connect to the
sexual organs. If there is damage men may find in
difficult to get or maintain an erection, and may have
problems with ejaculation. Women may experience
pain when having sex or a lack of lubrication fluids
(natural fluids in the vagina). If you do have
problems talk to you doctor or specialist nurse.
Dukes’ Staging
Doctors use a system to describe the different
stages of cancer of the large bowel – Dukes’ staging.
The staging system is based on the depth the
tumour has invaded through the bowel wall and
whether any cancer has spread to the lymph nodes
(lymph node metastasis).
After your operation the histopathologist will examine
the cancer under the microscope, we usually have
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the results within 14 days and will then be able to tell
you about the stage of your bowel cancer.
Dukes’ Stage
Dukes’ A
Extent of cancer
The cancer is confined to the bowel
wall
The cancer has spread through the
full thickness of the bowel wall, but
the lymph nodes are not affected.
The cancer has spread to the lymph
nodes. The lymph nodes are part
of the lymphatic system, which is
part of the body’s natural defence
against infection. This is one of the
first places the cancer can spread
to.
Dukes’ B
Dukes’ C
Medical Terms and Words
These are some of the medical words and terms you
may come across during your investigation and
treatment.
Abdomen
Adjuvant therapy
Anaemia
Analgesia
Anus
Caecum
Tummy or belly
Chemotherapy and radiotherapy
in addition to surgery
A reduction in the number of red
cells, haemoglobin (iron) or
volume of packed red cells in the
body
Pain killers such as paracetamol
and morphine
The opening to the back passage
The first part of the large intestine
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forming a dilated pouch into
which the ileum, the colon and
the appendix opens.
Chronic
Symptoms occurring over a long
period of time
Chemotherapy
Drug therapy used to attack
cancer cells
CNS
(Clinical A qualified nurse that has
Nurse specialist) specialised in a particular field of
care.
Colon
The large intestine (bowel)
extending from the caecum to
rectum
Colonoscopy
Inspection of the colon by an
illuminated telescope called a
colonoscope.
Colorectal
Surgeon who specialises in the
Surgeon
treatment of conditions in the
large bowel and rectum including
bowel cancer.
Colostomy
Surgical creation of an opening
between the colon and the
surface of the body. Part of the
colon is brought out of the
abdomen creating a stoma. A
bag is placed over this to collect
waste material.
Constipation
Infrequent or difficulty in the
passage of bowel motion stool
(faeces).
CT scan (CAT (computerised axial tomography)
scan)
A type of x-ray. A number of
pictures are taken of the
abdomen and fed into a computer
to form a detailed picture of the
inside of the body.
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Defaecation
Diagnosis
Diarrhoea
Electrolytes
Enema
Exacerbation
Faeces
Inoperable
Laxative
Lesion
Malignant
Mucus
Oncologist
Palliative care
Pathology
The act of passing faeces (having
your bowels opened)
Finding out what is wrong with
you
An increase in frequency and
liquidity of bowel motions
Salts in the blood e.g. Sodium,
potassium and calcium
A liquid introduced into the
rectum to encourage the passing
of motions
An aggravation of symptoms
The waste matter eliminated from
the anus (other names – stools,
motions, poo).
A growth or tumour that can not
be surgically removed
Medicine or tablet that acts to
cause emptying of the bowel.
This may be by purging (irritating
the lining) or increasing the
volume of stool (bulking)
A term used to describe any
structural abnormality in the body
Cancer
A white, slimy lubricant produced
by the large bowel
A doctor who specialises in
cancer care using drugs and
radiotherapy
Improving the quality of life by
providing support and the control
of
pain
and
unpleasant
symptoms.
The study of the cause of the
disease
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Radiotherapy
Rectum
Sigmoid
Sigmoidoscopy
Stricture
Suppository
Tumour
Ultrasound
The use of high energy rays
which attack cancer cells
The large intestine, above the
anus (the back passage)
The portion of the colon shaped
like a letter ‘S’ or ‘C’ extending
from the descending colon to the
rectum
Inspection of the sigmoid colon
with an illuminated telescope
called a sigmoidoscope
The narrowing of a portion of the
bowel
A bullet-shaped solid medication
put into the rectum
An abnormal growth which may
be benign (non-cancerous) or
malignant (cancer)
Use of high-pitched sound waves
to produce pictures of organs on
a screen for diagnostic purposes
Homerton Hospital Health and Cancer Information
Centre
Based at the front of the hospital
Tel: 020 8510 5191 (Mon – Friday 9am – 5pm)
Email: healthshop@homerton.nhs.uk
Homerton Health Shop is a drop-in Health and Cancer
Information Centre, based at the main entrance of the
Trust. Macmillan Cancer Information and Support
Manager provides cancer information, financial, practical
and emotional support to anyone affected by cancer, their
relatives, carers and friends.
Homerton Hospital PALS (Patients Advice & Liaison
Service)
PALS is based in the main entrance of the hospital.
Tel: 020 8510 7315 (9am – 5pm)
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Email: pals@homerton.nhs.uk
PALS provides confidential information and support,
helping you to sort out any difficulties or concerns you
have whilst in hospital, guiding you through the different
services from the NHS.
Useful Contacts
Beating Bowel Cancer
Harlequin House, 7 High Street, Teddington,
TW11 8EE
General Helpline: 08450 719 301
Nurse Advisory Service: 08450 719 301 (9.00am –
5.30pm)
Email: nurse@beatingbowelcancer.org
Website: www.beatingbowelcancer.org
Provides expert knowledge support, raising awareness
and information about bowel cancer so that individuals
can make their own informed decisions of their treatment.
Bowel Cancer UK
4 Rickett Street, London SW6 1RU
Tel: 020 7381 9711
Advisory line: 0800 840 35 40 (10.00am – 4.00pm)
Email: advisory@bowelcanceruk.org.uk
Web page: www.bowelcanceruk.org.uk
Advisory line staffed by specialist nurses providing advice
and information service for all those affected or
concerned about the disease.
Bowel cancer information in other languages available.
Cancer Research UK
Cancer Research UK, P.O. Box 123, Lincoln's Inn Fields,
London WC2A 3PX
Cancer information nurses: 0808 800 4040, 9am - 5pm
Email: cancerhelpuk@cancer.org.uk
Website: http://www.cancerresearchuk.org/cancer-help/
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Cancer Research UK is dedicated to cancer research,
provides information on site specific cancers and
influences public policies. The Website provides
information for bowel cancer patients.
Hackney Citizens Advice Bureau
Local Office: 300 Mare Street, London E8 1HE
Tel: 0870 126 4013
Website: http://www.eastendcab.org.uk/
Mare Street office offers drop-in clinics Monday-Thursday
from 8.30am. Friday doors open at 9.30am.
Advice line operates Tuesday and Wednesday from 1pm
– 3pm and 10am-12pm (for clients with mobility
problems). Tel: 0844 499 1195.
The Citizens Advice service helps people resolve their
legal, money and other problems by providing free
information and advice from over 3,000 locations, and by
influencing policymakers.
Colostomy Association
2 London Court, East Street, Reading, RG1 4QL
Tel: 0118 939 1537
Helpline: 0800 328 4257 (24 hour)
Email: cass@colostomyassociation.org.uk
Website: www.colostomyassociation.org.uk
Provides support and advice for colostomates, their
families and their carers. Free literature and information is
available about all aspects of living with a colostomy.
Core – Fighting Gut and Liver Disease
3 St Andrews Place, London, NW1 4LB
Telephone: 020 7486 0341
Email: info@corecharity.co.uk
Web page: www.corecharity.org.uk
Fund research in order to prevent, cure or treat digestive
disorders and provide information for sufferers, their
families and friends.
Ileostomy and Internal pouch support group
Peverill House,1 – 5 Mill Road, Ballyclare, Co. Antrim,
20
BT39 9DR.
Tel: 0800 0184 724 (Office hours)
Email: info@iasupport.org
Website: www.iasupport.org/uni_contact.aspx
Aims to help anyone who has had or is about to have
their colon removed and has an ileostomy or internal
pouch. Provides advice, information and leaflets.
Institute for Complementary Medicine (ICM)
32-36 Loman Street, London SE1 0EH
Tel: 0207 922 7980
Email: info@icnm.org.uk.
Fax: 0207 922 7981
Website: http://icnm.org.uk/
Provides the public with information on Complementary
Medicine
Macmillan Cancer Support
89 Albert Embankment, London SE1 7UQ
Macmillan cancer line: 0808 808 0000 (9am – 8pm)
Website: www.macmillan.org.uk
Provides specialist advice and support for cancer patients
and financial advice and grants for people with cancer
and their families.
NHS Choices
http://www.nhs.uk/Pages/HomePage.aspx
The Polyposis Registry
St. Mark’s Hospital, Northwick Park Hospital, Watford
Road, Harrow, HA1 3UJ
Tel: 020 8235 4270
Email: info@polyposisregistry.org.uk
Website: www.polyposisregistry.org.uk
Provides support and information to people who have, or
may have, the familial adenomatous polyposis (FAP)
gene, and so are at greater risk of developing bowel
cancer.
Other sources of information
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- www.rcoa.ac.uk “You
and your Anaesthetic”
- www.rcseng.ac.uk
Important information
Please remember that this leaflet is intended as general
information only. It is not definitive. We aim to make the
information as up to date and accurate as possible, but
please be warned that it is always subject to change.
Please, therefore, always check specific advice on the
procedure or any concerns you may have with your
doctor.
Hand Hygiene
In the interests of our patients the trust is committed to
maintaining a clean, safe environment.
Hand hygiene is a very important factor in controlling
infection. Alcohol gel is widely available throughout our
hospitals at the patient bedside for staff to use and also at
the entrance of each clinical area for visitors to clean their
hands before and after entering.
Other formats
If you require this leaflet in any other format e please
speak to your clinical nurse specialist (Keyworker).
Reference
The following team members have been consulted and
agreed this patient information:
Consultant, Clinical Nurse Specialist (Keyworker),
Macmillan Cancer Information and Support Manager and
Patient.
Produced: Colorectal team
Reviewed: May 2014
Next review date: May 2016
Homerton University Hospital NHS Foundation Trust
Homerton Row, London, E9 6SR
T 020 8510 5555
W www.homerton.nhs.uk
E enquiries@homerton.nhs.uk
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