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Hartmann's Operation of colorectal cancer



The resection is performed similar to a mesorectal excision.

  • A mid-line incision from the symphysis is normally extended to the right of the navel.
  • The sigmoid colon is released laterally.
  • The inferior mesenteric vessels are identified and divided distal to the left colic vessels.
  • The upper resection level is identified and the bowel is divided with a staple/dividing instrument.
  • The peritoneum is split on both sides of the rectum. The perimesorectal plane is followed dorsallyi and laterally. In front the plane is behind the vesicles and prostate/vagina. The dissection is followed all the way to the pelvic floor if the tumor is less than 12 cm from the anal verge, or 5 cm below the tumor if it is higher than 12 cm.
  • The sympathetic hypogastric nerve is identified if possible on the pelvic wall.
  • The parasympathetic pelvic plexus is often difficult to identify on the pelvic wall.
  • If possible, the bowel is closed at least 1 cm below the tumor.
  • The distal end is rinsed with distilled water.
  • A new row of staples is set at the desired level and the bowel is split between the rows of staples.


  • Sigmoideostomy is made in the marked area of the left rectal sheath.
  • Vacuum drain is put in the pelvis.
  • The abdomen is closed.

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