Hartmann’s Procedure: Why It’s Done, Life With the Colostomy, and Reversal

What is a Hartmann's procedure?

A Hartmann's procedure is an operation that removes a damaged part of the lower colon, usually the sigmoid, and brings the healthy end of the colon out through the belly as an end colostomy. The rectum is closed and left inside, so the bowel is not joined back together at that point.

It is named after Henri Hartmann, the French surgeon who described it in the 1920s. Surgeons choose it when joining the bowel straight away would be risky: for example, when the belly is infected, the bowel is inflamed or the person is very unwell. Leaving the bowel unjoined for now avoids a leak at a fresh join, which is one of the most dangerous complications in bowel surgery.

After the operation, stool comes out through the colostomy into a pouch. The closed-off rectum stays in place, which is why many people still pass a little mucus from their bottom. Our guide to pooping with a colostomy bag explains why that's normal.

Why surgeons do a Hartmann's procedure

Most Hartmann's procedures in the US are done in an emergency or close to it. The most common reasons are:

• Complicated diverticulitis. When an inflamed pouch in the colon bursts (a perforation), causing infection or pus in the belly. This is the most common reason.
• Bowel cancer causing a blockage or a tear, especially when the person is too unwell for a longer operation.
• A bowel obstruction, for example from a twisted colon (volvulus).
• Injury or trauma to the lower colon, or a perforation during another procedure.
• Loss of blood supply to part of the colon (ischemia).

Not everyone with these conditions needs a Hartmann's. Today, some surgeons join the bowel straight away and protect the join with a temporary loop ileostomy instead. Which option is safer depends on how sick you are, how much infection there is, and the surgeon's experience. If your surgery is for cancer, our guide to colon cancer and ostomy surgery covers the questions worth asking.

Recovery after a Hartmann's procedure

• In the hospital

  Usually about a week, sometimes longer after an emergency with infection. Your stoma nurse teaches you to empty and change the pouch before you go home.

• Weeks 1–6

  Tiredness is normal, especially after an emergency. Short walks every day, no heavy lifting, and plenty of rest. The stoma is swollen at first and shrinks, so measure it at every change.

• Weeks 6–12

  Most people return to light work, driving and normal routines. Output from a sigmoid colostomy usually becomes formed and fairly predictable.

• Months 3–6 and beyond

  Energy comes back fully. This is when you and your surgeon usually start talking about whether a reversal makes sense.

Our ostomy recovery week by week guide goes into the first month in detail.

Living with the colostomy after a Hartmann's

A Hartmann's leaves an end colostomy, usually on the lower left side of the belly. Output is often formed, much like before, and comes once to three times a day. Many people use closed pouches they simply replace, and some learn colostomy irrigation to empty the bowel on a schedule.

Most people go back to work, travel, exercise and their usual clothes. A high-waisted brief or a soft wrap keeps the pouch flat under trousers and dresses, and an ostomy belt gives support when you're active or lifting, once your surgeon says it's time. A parastomal hernia is more common after an end colostomy, so it's worth asking your stoma nurse about support garments early. Our guide to living with a colostomy bag covers daily life in more detail.

Can a Hartmann's procedure be reversed?

Often, yes. A Hartmann's reversal reconnects the colon to the closed rectum, so stool passes through the bottom again and the colostomy is closed. It is usually considered three to six months or more after the first operation, once you have fully recovered and any infection has gone.

Not everyone has a reversal. Many people, often quoted at around half, keep their colostomy, either because surgery would be risky for them or because they feel well with the stoma and don't want another operation. That is a valid choice, and a common one. If you do go ahead, our guides to common problems after stoma reversal and temporary vs permanent ostomy explain what to expect.

Questions to ask your surgeon

• Why was a Hartmann's chosen instead of joining the bowel straight away?
• How much of my colon was removed, and how long is the rectal stump?
• Am I likely to be a candidate for a reversal, and when could we talk about it?
• What tests would I need before a reversal?
• What can I do now to lower my risk of a parastomal hernia?
• Who do I call about leaks, sore skin, or mucus or bleeding from my bottom?

If a planned reversal is coming up, our preparing for ostomy surgery checklist works for the second operation too.

Hartmann's procedure: your questions