Laparoscopic Hartmann’s Procedure

Abstract

Hartmann’s procedure is most commonly performed for complicated diverticular disease, particularly perforation of a diverticulum of the sigmoid colon in acute diverticulitis. It is usually an emergency procedure and can be carried out with a laparoscopic technique in many patients. Sepsis with haemodynamic instability can be a contraindication for a laparoscopic approach to Hartmann’s procedure in centres that do not routinely perform emergency laparoscopic surgery. An alternative laparoscopic approach for management of patients with Hinchey III diverticulitis would be emergency laparoscopic lavage followed by an elective resection (White et al., Dis Colon Rectum 53:1537–1541, 2010). Other indications for Hartmann’s procedure include sigmoid obstruction due to benign or malignant disease, fistulae, ischaemia or volvulus. Hartmann’s procedure is also performed for cancer and in that case it should be a radical procedure with proximal ligation of vessels.