Hartmann’s Procedure
What is Hartmann’s Procedure?
Hartmann’s procedure is a surgical intervention involving the resection of a diseased portion of the colon (usually the sigmoid colon or rectum), closure of the distal rectal stump, and creation of an end colostomy to divert stool through an abdominal stoma. It is typically performed in emergencies for conditions like perforated diverticulitis or colorectal cancer with obstruction, where immediate bowel reconnection is unsafe. In India, Hartmann’s procedure is conducted in specialized colorectal surgery centers, offering high-quality emergency care at affordable costs. For patients and families in India, understanding the procedure, costs, recovery, risks, and frequently asked questions (FAQs) is essential for informed decision-making and optimal outcomes.
Why do you need Hartmann’s Procedure?
Hartmann’s procedure is indicated for:
- Complicated diverticulitis: Perforation, abscess, or peritonitis requiring urgent resection.
- Colorectal cancer: Obstructing or perforated tumors, particularly in the sigmoid colon or rectum, unsuitable for primary anastomosis.
- Bowel perforation: Due to trauma, ischemia, or infections (e.g., typhoid).
- Obstruction: From volvulus, strictures, or tumors causing acute blockage.
- Inflammatory bowel disease (IBD): Severe ulcerative colitis or Crohn’s disease with complications like perforation or toxic megacolon.
The procedure aims to remove diseased or damaged bowel, control infection or obstruction, and create a temporary (often reversible) colostomy to allow healing. In India, hospitals like Apollo, Fortis, Tata Memorial, Medanta, and AIIMS specialize in Hartmann’s procedure, often using open surgery for emergencies or laparoscopic techniques in select cases.
Why Do Hartmann’s Procedure Costs Vary in India?
The cost of Hartmann’s procedure in India ranges from ₹1.5 lakh to ₹6 lakh, depending on:
- Procedure Type:
- Open Hartmann’s: ₹1.5–4 lakh
- Laparoscopic Hartmann’s: ₹2.5–5 lakh
- Robotic-assisted: ₹4–6 lakh
- Hospital & Location: Top hospitals in metro cities (e.g., Apollo, Tata Memorial) charge more; government hospitals (e.g., AIIMS) cost ₹50,000–₹2 lakh but may have limited emergency capacity.
- Specialist Expertise: Experienced colorectal surgeons or surgical oncologists charge higher fees.
- Extra Costs: Diagnostics (CT, blood tests), ICU stays, medications, colostomy supplies (₹2,000–₹5,000 monthly), or post-surgery treatments (e.g., chemotherapy) add to expenses. Complications increase costs.
- Insurance & Aid: Most insurance plans cover Hartmann’s for emergencies (e.g., perforation, obstruction); Ayushman Bharat offers free or subsidized treatment at empanelled hospitals.
Hartmann’s Procedure
The procedure is typically performed in emergencies, tailored to the patient’s condition and extent of disease:
- Before Procedure Evaluation:
- Diagnosis is confirmed via:
- CT scan: Identifies perforation, abscess, or obstruction, showing free air or fluid in the abdomen.
- X-ray: Detects pneumoperitoneum (free air) in perforation cases.
- Blood tests: Assess infection (elevated white cell count), sepsis, or organ function.
- Patients are stabilized with IV fluids, broad-spectrum antibiotics (e.g., ceftriaxone, metronidazole), and pain management.
- Bowel preparation is usually avoided due to the emergency nature, but a nasogastric tube may decompress the stomach.
- An enterostomal therapist marks the stoma site pre-surgery, if possible.
- Diagnosis is confirmed via:
- Surgical Technique:
- Open Hartmann’s Procedure:
- Performed under general anesthesia, lasting 2–4 hours.
- A midline abdominal incision provides access to the peritoneal cavity.
- The surgeon:
- Resects the diseased colon segment (e.g., sigmoid colon for diverticulitis).
- Closes the distal rectal stump (left in place) with sutures or staples to prevent leakage.
- Creates an end colostomy by bringing the proximal colon through the abdominal wall to form a stoma, where a colostomy bag collects stool.
- Performs peritoneal lavage to clean contamination from perforation or abscesses.
- Drains may be placed to manage residual fluid or infection.
- Laparoscopic Hartmann’s Procedure:
- A minimally invasive approach using 3–5 small incisions, a laparoscope (camera), and specialized instruments.
- Suitable for stable patients with less severe contamination (e.g., early perforation), offering less pain and faster recovery.
- Takes 2–3 hours, with conversion to open surgery possible if complications arise.
- Robotic-Assisted Hartmann’s Procedure:
- Rare, but used in select centers (e.g., Apollo, Medanta) for enhanced precision, particularly in complex cases.
- More expensive due to advanced technology.
- Open Hartmann’s Procedure:
- After Procedure:
- Patients are monitored in the ICU for 1–3 days to manage sepsis, pain, and stoma function.
- Hospital stay lasts 5–10 days for open surgery or 3–7 days for laparoscopic surgery.
- Antibiotics continue for 5–7 days or longer for severe infections.
- An enterostomal therapist trains patients on colostomy care, including bag changes and skin protection.
- Pathology reports guide further treatment (e.g., chemotherapy for cancer).
Recovery After Hartmann’s Procedure
Recovery involves physical healing, infection control, and adaptation to a colostomy:
- Hospital Stay:
- Open surgery requires 5–10 days, including 1–3 days in the ICU.
- Laparoscopic surgery involves 3–7 days, with 1–2 days in the ICU.
- Post-Procedure Care:
- Pain is managed with medications (e.g., opioids initially, then NSAIDs).
- IV fluids and gradual oral intake (clear liquids to soft foods) support recovery, with bowel function via the stoma starting in 2–5 days.
- Antibiotics treat peritonitis or sepsis; drains are removed when output decreases.
- Colostomy training includes changing bags (every 3–7 days), cleaning the stoma, and preventing skin irritation.
- Activity and Diet:
- Light walking resumes within 1–2 days to prevent blood clots.
- Strenuous activities, heavy lifting, or driving are avoided for 6–8 weeks (open surgery) or 4–6 weeks (laparoscopic).
- A low-residue diet (e.g., white rice, bananas) is followed for 2–4 weeks, avoiding gas-producing foods (e.g., beans, broccoli).
- Hydration and colostomy-compatible foods prevent blockage or irritation.
- Follow-Up:
- Follow-up visits at 1–2 weeks and 4–6 weeks assess wound healing, stoma function, and recovery.
- Imaging (CT, colonoscopy) and CEA levels monitor for cancer recurrence or complications.
- Colostomy reversal is considered after 3–6 months if the rectal stump is viable and the patient is stable, requiring another surgery (reversal success rate: 60–80%).
Most patients adapt to colostomy within 4–8 weeks, resuming normal activities in 6–12 weeks. Survival rates exceed 80–90% with prompt surgery, though outcomes vary by cause (e.g., better for diverticulitis than advanced cancer).
Risks and Complications
Hartmann’s procedure is a major emergency surgery with significant risks:
- Surgical Risks:
- Bleeding, infection, or wound dehiscence at the incision or stoma site.
- Injury to nearby organs (e.g., bladder, ureters).
- Stoma-Related Complications:
- Stoma prolapse, retraction, or blockage, requiring revision.
- Parastomal hernia (10–20%) or skin irritation around the stoma.
- General Risks:
- Adverse reactions to anesthesia.
- Blood clots (deep vein thrombosis or pulmonary embolism), requiring anticoagulants.
- Persistent peritonitis or abscesses, needing prolonged antibiotics or drainage.
- Disease-Specific Risks:
- Cancer recurrence or metastasis, requiring further therapy.
- Persistent inflammation in IBD patients if disease extends beyond the resected area.
- Long-Term Issues:
- Non-reversible colostomy (20–40% of cases) due to rectal stump issues or patient frailty.
- Adhesions causing bowel obstruction, potentially needing surgery.
Prompt reporting of symptoms like fever, no stoma output, or severe pain ensures timely management.
Frequently Asked Questions (FAQs)
What causes the need for Hartmann’s procedure?
Common causes include perforated diverticulitis, colorectal cancer with obstruction/perforation, bowel ischemia, or severe IBD complications.
Is Hartmann’s procedure always permanent?
The colostomy is often temporary, with reversal possible after 3–6 months if the patient is stable. Permanent colostomy occurs if the rectal stump cannot be reconnected or the patient’s health prohibits further surgery.
Can Hartmann’s procedure be done laparoscopically?
Yes, in stable patients with minimal contamination, but open surgery is standard for emergencies like perforation or sepsis.
How soon can I resume normal activities?
Laparoscopic patients resume activities in 4–6 weeks; open surgery patients take 6–8 weeks.
Is Hartmann’s procedure covered by insurance in India?
Most insurance plans cover it for emergencies like perforation or obstruction. Confirm with your provider.
What are the signs of complications post-Hartmann’s procedure?
Fever, no stoma output, severe pain, or skin irritation around the stoma require immediate attention.
Can elderly patients undergo Hartmann’s procedure?
Yes, if their health permits, though laparoscopic approaches reduce risks and recovery time.
What lifestyle changes are needed post-Hartmann’s procedure?
Maintain a balanced diet, stay hydrated, practice diligent colostomy care, avoid heavy lifting, and attend follow-ups, especially for cancer patients.
Conclusion
Hartmann’s procedure is a critical emergency surgery for life-threatening colorectal conditions, effectively managing perforation, obstruction, or infection with a temporary or permanent colostomy. With expertise in open and laparoscopic techniques, India’s top hospitals (Apollo, Fortis, AIIMS) offer affordable, high-quality care. By understanding the procedure, cost variations, recovery, risks, and FAQs, patients and families can approach Hartmann’s procedure with confidence. For urgent symptoms like severe abdominal pain or fever, seek immediate care at a surgical center to ensure prompt treatment.
Looking for Best Hospitals for Hartmann’s Procedure
Note: we are not promoting any hospitals
we are not promoting any hospitals we sourced all the details from google and hospitals website, please verify and start with your surgery here we go the list includes government, budget and superspeciality hospitals accreditation bodies are the National Accreditation Board for Hospitals and Healthcare Providers (NABH) and the Joint Commission International (JCI)
- click on your city and schedule your surgery now done in good hands.
| City | Minimum Price (₹) | Maximum Price (₹) |
|---|---|---|
Agra |
2,00,000 |
5,00,000 |
Ahmedabad |
2,50,000 |
5,50,000 |
Ajmer |
2,00,000 |
5,00,000 |
Aligarh |
2,00,000 |
5,00,000 |
Allahabad |
2,00,000 |
5,00,000 |
Amritsar |
2,25,000 |
5,25,000 |
Aurangabad |
2,25,000 |
5,25,000 |
Bangalore |
2,50,000 |
5,50,000 |
Bareilly |
2,00,000 |
5,00,000 |
Belgaum |
2,25,000 |
5,25,000 |
Bhopal |
2,25,000 |
5,25,000 |
Bhubaneswar |
2,25,000 |
5,25,000 |
Bikaner |
2,00,000 |
5,00,000 |
Chandigarh |
2,50,000 |
5,50,000 |
Chennai |
2,50,000 |
5,50,000 |
Coimbatore |
2,50,000 |
5,50,000 |
Dehradun |
2,25,000 |
5,25,000 |
Delhi |
2,50,000 |
5,50,000 |
Dhanbad |
2,00,000 |
5,00,000 |
Durgapur |
2,00,000 |
5,00,000 |
Faridabad |
2,50,000 |
5,50,000 |
Ghaziabad |
2,50,000 |
5,50,000 |
Gorakhpur |
2,00,000 |
5,00,000 |
Guntur |
2,25,000 |
5,25,000 |
Gurgaon |
2,50,000 |
5,50,000 |
Guwahati |
2,25,000 |
5,25,000 |
Gwalior |
2,00,000 |
5,00,000 |
Hyderabad |
2,50,000 |
5,50,000 |
Indore |
2,25,000 |
5,25,000 |
Jabalpur |
2,00,000 |
5,00,000 |
Jaipur |
2,50,000 |
5,50,000 |
Jalandhar |
2,25,000 |
5,25,000 |
Jamshedpur |
2,25,000 |
5,25,000 |
Jodhpur |
2,00,000 |
5,00,000 |
Kanpur |
2,00,000 |
5,00,000 |
Kochi |
2,50,000 |
5,50,000 |
Kolkata |
2,50,000 |
5,50,000 |
Kollam |
2,25,000 |
5,25,000 |
Lucknow |
2,25,000 |
5,25,000 |
Ludhiana |
2,50,000 |
5,50,000 |
Madurai |
2,25,000 |
5,25,000 |
Mangalore |
2,25,000 |
5,25,000 |
Meerut |
2,00,000 |
5,00,000 |
Moradabad |
2,00,000 |
5,00,000 |
Mumbai |
2,50,000 |
5,50,000 |
Mysore |
2,50,000 |
5,50,000 |
Nagpur |
2,25,000 |
5,25,000 |
Nashik |
2,25,000 |
5,25,000 |
Navi Mumbai |
2,50,000 |
5,50,000 |
Noida |
2,50,000 |
5,50,000 |
Patna |
2,00,000 |
5,00,000 |
Pune |
2,50,000 |
5,50,000 |
Raipur |
2,25,000 |
5,25,000 |
Rajkot |
2,25,000 |
5,25,000 |
Ranchi |
2,00,000 |
5,00,000 |
Surat |
2,50,000 |
5,50,000 |
Thane |
2,50,000 |
5,50,000 |
Vadodara |
2,25,000 |
5,25,000 |
Varanasi |
2,00,000 |
5,00,000 |
Visakhapatnam |
2,25,000 |
5,25,000 |
Disclaimer
This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.