Hartmann's operation is performed as a treatment for colon cancer. In most cases, it is the surgical method of treating the disease that is not only the most effective, but also the only one, since chemotherapy for cancer that progresses in this particular area does not give proper results.
Indications for surgery
Hartmann-type operation is indicated for debilitated and elderly patients diagnosed with Cancer of the sigmoid colon or rectosigmoid region. There are other reasons why a doctor may order a Hartmann operation:
- complicated obstruction of these areas (in most cases, food does not move through the intestines at all);
- perforation (perforation of the intestine);
- volvulus of the sigmoid colon in case of complication of the condition by gangrene or peritonitis (lengthening of the intestine, deformation of its mesentery).
It is performed, as a rule, according to emergency indications, for example, with the manifestation of tumor decay or obstructionguts.
Operation Hartmann: stages of implementation
Most patients spend only the first stage. The next stage, with a favorable recovery period, is carried out only six months later.
Hartmann's operation, described by Petrov B. A., is divided into two stages. Used to treat the descending and transverse colon.
So, the whole operation consists of the following steps:
- This stage was described by B. A. Petrov, who gave it the name “obstructive resection”. Very often, patients with a diagnosis of cancer undergo only this procedure. It consists in removing a certain part of the intestine, on which the tumor is located. After that, the lumen of the distal segment is stitched together. This is done tightly, and the lumen itself is left in the abdominal cavity. The proximal end of the operated intestine is brought out by the surgeon to the abdominal wall from its anterior part. This conclusion is called a colostom, which will be described in more detail later.
- The second stage, with a favorable course of the rehabilitation period, is carried out no earlier than two months later, in some cases even six months later. It consists in restoring the continuity of the colon by end-to-end anastomosis. The colostomy is then removed. A side-to-side anastomosis is possible, but in most cases surgeons reject it.
Preparing the patient for surgery
First of all, the procedure for preparing the patient for its implementation is carried out. Since they usually make her sick, weakened, emaciated, it is necessary to conduct a series of examinations, as well as a general strengthening treatment so that a person can endure the operation without a fatal outcome. Means are used for this, the action of which is aimed at activating cardiac activity, regulating the work of the gastrointestinal tract, possibly blood transfusion, as well as prescribing a large amount of vitamins and a special diet.
Hartmann operation: technique
For the operation, the patient is laid on his back. The abdominal cavity is opened with a lower median incision from the pubis and 5 cm (sometimes a little less) above the navel. After that, the patient is transferred to the Trendelenburg position (the head and shoulder girdle of the patient are located below the pelvic region). Next, the so-called mobilization of the sigmoid colon is carried out, for this purpose a towel is usually used. A certain amount of novocaine (about 250 ml) is usually injected into the root of the mesentery, as well as under the peritoneum of the Douglas pocket. Now a revision is being carried out and the localization of the tumor and its other characteristics are specified. The sigmoid colon, on which the operation is performed, must be brought into the wound and taken to the right side closer to the midline. The mesentery is stretched. Next, scissors are used to cut the outer sheet of the peritoneum. It is carried out in the place where the root of the mesentery is located. The dissection is carried out along the entire length of the loop, which will subsequently be removed. After that, the intestine is retracted outward, and the inner sheet of the peritoneum is dissected. Second and thirdthe arteries are crossed in the place that was previously placed between the clamps. This place is characterized by a departure from the inferior artery of the mesentery. Then it is tied with silk thread. The surgeon carefully ensures that the left artery is preserved, if possible, the doctor also saves the superior and rectal arteries.
The mesentery is also clamped on both sides and intersected between the instruments, after which the vessels passing inside it are additionally tied up.
If the upper ampulla is removed, the artery of the rectum, which is at the very top, is bound without fail.
Clamps are applied in the following places:
- over the affected area of the intestine;
- upper ampullar segment of the rectum.
Between these clips, the affected intestine is removed with a sharp scalpel. This happens within he althy areas. The end of the intestine is tightly sutured. Used for this catgut and silk threads.
Post-operative period
During this period, the following actions are performed:
- Through special tubes three times a day the intestines are washed. A weak solution of antiseptics is used for this, the appointment of which the doctor decides on the basis of tests.
- Antibiotics are administered within five days.
- A special diet is prescribed, during which you can takeexclusively liquid food.
- Doctor prescribes medications that help hold stools.
Intestinal lavage tubes are removed 7-9 days after surgery.
After 3-6 months of the postoperative period, subject to its favorable course, intestinal continuity can be restored, as well as the removal of an unnatural anus.
Possible complications after surgery
The main complication, which can be very dangerous for the patient's he alth, is bleeding. It can occur both during the operation and after it.
After the operation, shock may occur, which also threatens the patient's life. Statistics says that most often, those operated on die within one or two days after the operation.
The most common complication is infection in the wound. To avoid this, especially careful preparation of the intestine itself for surgery is required in order to save the patient from having to defecate in the first days of the postoperative period. If, due to the narrowing of the intestine, it is not possible to remove its contents, then the operation takes place in two stages, which were described in the first half of the article.
Post-op procedures
During rehabilitation, urinary retention may occur, and complaints from patients, as a rule, do not come. Urine is removed artificially, and this happens only 10 hours after the completion of the operation. The procedure is carried out at least three times a day. Ignoring this can lead to the fact that the bladder simply stretches, tilts backwards and naturally loses the ability to contract.
Instead of a conclusion
The effectiveness of the operation is influenced by many factors, in particular, the patient's condition before the operation, the timing of the surgical intervention, the choice of the correct method of conducting the operation. Despite this, in many cases Hartmann colon surgery may be the only treatment option.
