Reversal of Hartmanns procedure Figure

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The reversal of the Hartmann's procedure is the second stage of the operation. To most patients this is the most important part of the whole process. The operation does carry risks and is not as easy and straightforward as reversal of a loop colostomy. Hartmann's procedure involves

Reversal Hartmann Procedure
Figure 7.3 Reversal of Hartmann's procedure. (Courtesy of Dansac Ltd.)

another laparotomy and all the inherent risk associated with major bowel surgery.

One of the first remarks that the surgeon will make to the patient is: 'We had to give you a bag, but it's temporary and can be reversed.' The first question the patient has is: 'How long will I have the bag?' One or two patients believe that temporary means that the bag will be reversed before they are discharged home. A number of hospitals are able to give the patient a date for reversal of their colostomy. Unfortunately, this is not possible in most district general hospitals because of the restraints on bed availability and government targets. The reversal operation is not a life-saving procedure and, in the district general hospital, the patient is placed on the general waiting list.

The reversal operation (Keighley and Williams, 1997) is not without risk and will mean another length of stay in hospital. There has been research in Denmark about a fast-track rehabilitation after closure of a Hartmann's procedure from Basse et al. (2000). The conclusion of the study was that the inclusion of the multidisciplinary team after revision of the Hartmann's procedure reduces morbidity and hospital stay. Other hospitals are now performing laparoscopic closure of Hartmann's procedure which is proving to require shorter hospital admission (Sosa et al., 1994; Holland et al., 2002).

The patient's reversal operation may never take place; the patient may prefer not to have further surgery and be at ease with the stoma. Alternatively, the patient may have other medical problems that make surgery not feasible, or the patient may not be medically fit for surgery. Even though the intention of the surgeon will be to reverse the stoma, it may be technically impossible to reverse it and this may not be apparent until during the operation. The reversal of the Hartmann's procedure is not guaranteed and can leave the patient with a permanent end-colostomy.

The patient will need counselling from the specialist nurse about the nature of the surgery and the risks involved. The patient has to appreciate all the risks of an anaesthetic and surgery, as well as the specific risks associated with the reversal. Frequently patients put their lives on hold until the reversal operation, which involves not returning to everyday living, or work, and not seeing anyone outside their immediate family. This will place a strain on their lives and on their loved ones and impede their recovery. The ethos of this surgery is for the patient to return to their normal everyday living as soon as possible. In hospitals where a date for reversal is given to the patient at the time of discharge, a patient can plan and look forward to the future. The British Colostomy Association offers support, help, advice and leaflets on the reversal operation.

The operation involves reopening the old laparotomy scar, taking the colostomy back into the abdomen, and joining the proximal end to the distal end of the colon. The patient will then have two scars: the laparotomy scar and the scar where the colostomy was in the left iliac fossa.

After the operation to reverse the stoma, the patient experiences all the usual postoperative recovery episodes. The patient may experience a time of adjustment with bowel habit. It may mean that motions are looser and more frequent than before surgery or everything could revert back to normal. Some patients take a long time for their bowels to settle after reversal and loose frequent motions are a problem for them. Jelly babies and marshmallows (Black, 2000) work in helping to thicken the output if it is very watery. Incontinence can also be a factor after reversal; usually all these symptoms do settle eventually. Patients need to be aware that their normal bowel habit from before their original surgery has gone and a new habit will emerge. Most patients will recover very well and put all their anxieties of having a colostomy behind them and, for most, they will forget this period in their life. A few will still have problems: usually the length of time that it takes for them to recover and feel well again. Patients who have had surgery on their bowel still have access to the colorectal specialist nurse and will keep in contact if they have any worries.

The stoma care nurse specialist is the most appropriate person to counsel the patient with all the relevant information about reversal of colostomy and the recovery and convalescence period.

Complications of reversal of Hartmann's procedure

One of the main complications for the reversal of Hartmann's procedure surgery is the failure to reverse the stoma. A number of patients do opt not to go through the reversal procedure, some because of the risks of survival; others because they have accepted their colostomy and it has not caused them any problems. The author (CH) did have a 92-year-old patient whom the surgeons asked her to convince that he would be better off with his colostomy reversed. This man said 'My dear, why would I want to go through more surgery? When I go on an outing I don't have to rush to the toilet, my bag is convenient.'

Surgeons do appear to assume that everyone who has a stoma will want to have it reversed. Patients must be given all the options and allied risks, and be left to make up their own minds. For the patient who is desperate for reversal, this is not an option; they want their colostomy reversed at any cost. The patient who goes to theatre expecting to have the colostomy reversed and wakes up with it still there is in a desperate situation.

Patients have usually placed all their hopes and faith in having the colostomy reversed and never for one moment give any consideration to the possibility that it may not be possible. They are counselled at length about all the possible outcomes, but they do not appear to listen or remember that they may wake up with the colostomy. Patients feel let down and that they have somehow failed. These situations do not happen often but the possibility always has to be considered. At some hospitals this problem does not arise and colostomy reversals always happen. When the colostomy is not reversible for whatever reason, patients will require the advice and support of the stoma care nurse. Counselling these patients and offering explanations take all the expertise of the specialist nurses.

Other complications of reversal are wound healing. If the patient had problems with the wound healing after the first operation, the wound may take the same route. The stoma site can, in addition, have problems with healing. This can cause the patient emotional distress, because it will appear to him or her that the colostomy has reappeared. The patient will require wound assessment and appropriate dressing.

Another complication is the slowness of the bowel to resume its role of defecation. Patients often assume that, because they have been starved of food and drink, their bowels have no chance of working and do not appear to appreciate the importance of this complication. Fluid intake needs encouragement as well as diet. As a result of the fact that the patients have been starved, they become dehydrated and this is often the cause of lack of bowel activity. Most patients will have a bowel action by day 10. For those very few who fail to achieve this, it will be necessary for the surgical team to intervene for assessment. The first investigation will be a plain abdominal radiograph and then assessment. Surgery to address this problem is rare.

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Responses

  • dale
    How long to heal after hartmanns reversal?
    7 years ago
  • Thea
    Is a hartmann's procedure ever reversed?
    6 years ago
  • Essi
    How long does it take to get over hartmans surgery?
    2 years ago
  • mac shaw
    CAN HARTMANNS PROCEDURE BE REVERSED?
    2 years ago
  • leighton
    How long does it take for the bowel to start working after reversal of a Hartmanns procedure?
    2 years ago
  • jan
    How long to heal after Haartmans reversal operation?
    2 years ago
  • Kerry
    Why would a hatrmann procedure be reversed?
    2 years ago
  • Izaak
    Can a hARTMANS PROCEDURE BE REVERSED?
    2 years ago
  • Awet
    What is reversal of hartmann procedure?
    2 years ago
  • earl
    IS HARTMANN'S PROCEDURE REVERSIBLE?
    2 years ago
  • adolfo udinesi
    How long does hartmann procedure take?
    2 years ago
  • mario
    Do surgeons do illeostomy with Hartmans reversal?
    2 years ago
  • saimi
    What is the externalized part of a hartmans colostomy?
    1 year ago
  • Negassi Afwerki
    How long does it.take in.theater for reversal of Stoma?
    1 year ago
  • blair aitken
    How to code reverse colostomy hartman procedure?
    1 year ago
  • alessio rossi
    What is the purpose of a hartmann colostomy reversal?
    1 year ago
  • fre-qalsi
    How long to wait to do a reversal hartmann?
    1 year ago
  • BRHANE
    Can stoma be reversed if divaticular disease in bowl?
    12 months ago
  • Alexa
    How does a doctor reverse hartmann's procedure?
    11 months ago
  • henna
    What is a second stage hartman procedure?
    11 months ago
  • lavinia
    What are the chances of a hartmann procedure coming undone after 3 years?
    10 months ago
  • Earl
    Is diarfhea common after hartmans prosedure reversale?
    10 months ago
  • jan hasu
    Can the ostomy be reversed in a hartman procedure?
    9 months ago
  • DIANA
    What is the pdx diagnosis for the reversal of a hartman's?
    9 months ago
  • Michael Green
    How to code closure of hartmann's pouch?
    8 months ago
  • keiran
    How long to wait for hartmans procedure reversal?
    7 months ago
  • Mac
    Can you reverse hartmanns procedure?
    7 months ago
  • shannon sutherland
    What can happen after the hartmans operation reversal?
    6 months ago
  • salvia
    What is the difference between hartmann's reversal and ostomy reversal?
    6 months ago
  • folcard
    Why is a colostomy takedown done?
    5 months ago
  • Pierino
    What to feed reverse surgery on colon patient?
    4 months ago
  • johanna
    What is EA dilator during reversal of hartman surgery?
    4 months ago
  • destiny
    How does the hartmann's pouch and end ileostomy work?
    3 months ago
  • SIMRET
    What part of the colon is used when reversing a hartmann's?
    3 months ago
  • selassie
    Is hartmanns procedure inpatient status?
    3 months ago
  • Samppa
    Is hartmanns reversible?
    2 months ago
  • Charley
    Is excsion included in hartmann colostomy reversal procedure?
    2 months ago
  • Wilma
    How long is the average midline scar when performing a hartmann procedure?
    2 months ago
  • Oona
    How long should a hartman reversal take?
    2 months ago
  • senay
    How do you code reversal hartmann's reversal with diverting loop ileostomy procedure?
    21 days ago

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