What is reversal of Hartmann's disease?
A reversal of Hartmann’s operation is to enable your bowel to be re-joined and get rid of the present stoma / colostomy.
The procedure is performed under general anaesthetic.
You have already had an operation called a Hartmann’s procedure where part of your large bowel (colon) was removed and a stoma (a colostomy or occasionally an ileostomy) created. The lower end of the large bowel (rectum) has been closed and left inside your abdomen.
In this reversal of Hartmann’s operation, the aim is to take down the stoma and join it back to the closed lower end (rectum). This will re-establish the continuity of your bowel to allow passage of stool (bowel motions) through the back passage (anus) again.
The aim of the surgery is to remove the stoma, re-join the cut ends of bowel and enable passage of stools / motions via the back passage again. For most patients this will be the last operation relating to this episode.
What does the operation involve?
You will be asked to drink some fluids that are high in carbohydrates to give you energy for the operation. The operation is performed under a general anaesthetic and usually takes between 4 to 5 hours. Your surgeon will make a cut through the scar from the first operation and a cut in the skin around the colostomy. They will free up the end of the bowel inside your abdomen and the end used to make the colostomy. Your surgeon will join the two ends back together and place the bowel inside the abdominal cavity. At the end of the operation, your surgeon will close the cut around the colostomy and the cut in your old scar with stitches.
They will place a drip (small tube) in a vein in your arm. They will also place a catheter (tube) in your bladder to help you pass urine. They may also place a small tube in your abdomen to drain away fluids that can sometimes collect after the operation.
For more information, and if you have any queries about the procedure, speak to your consultant.
Continue taking your normal medication unless you are told otherwise.
The following lifestyle changes can help make the procedure a success:
- Giving up smoking
- Eating healthily. If overweight, you have a greater chance of developing complications
- Exercising regularly. Your GP can recommend exercises.
What are the possible complications?
- Pain, which happens with every operation
- Bleeding after surgery. This is usually minor
- Infection in the surgical wound, which may need treatment with antibiotics or further surgery
- Chest infection
- Unsightly scarring of the skin
- Developing a hernia in the scar caused by the deep muscle layers failing to heal. If this causes problems, you may need further surgery
- Anastomotic leak. This is a serious complication that may happen if the join (anastomosis) between the ends of the bowel fails to heal, leaving a hole. Bowel contents leak into the abdomen, leading to pain and serious illness. This often needs another operation
- Diarrhoea, which is quite common, but should gradually improve with time.
This is not a definitive list and symptoms will vary with each patient. Please ask your consultant for more information.
What does the recovery involve?
It is usual for your bowel to stop working for a few days. The healthcare team will restrict the amount of fluid you drink to stop you being sick. Over the next few days they will gradually allow you to drink and then eat normally. The drip, the catheter and drain (if you have one) will be removed when you no longer need them.
You should be able to go home seven to ten days after the operation. However, your doctor may recommend that you stay a little longer. Remember, you won’t be able to drive after the operation.
It can take up to three months to return to normal activities. You may find that you need to move your bowels more often, but this usually settles down with time. Regular exercise should help your recovery – ask your GP for advice.
For further information, speak to your consultant.
How to pay for your operation
Reversal of Hartmann’s procedure costs are covered by most medical insurance policies, but please check with your insurer first. If you are paying for your own treatment the cost of the operation will be explained and confirmed in writing when you book the operation. Ask the hospital for a quote beforehand, and ensure that this includes the surgeon’s fee, the anaesthetist’s fee and the hospital charge for your procedure.