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What Is Hartmann Reversal?

Hartmann reversal is surgery that restores intestinal continuity after a previous Hartmann procedure. The surgeon closes the end colostomy, frees the remaining colon, and reconnects it to the rectal stump with a colorectal anastomosis. The operation can be performed through an open, laparoscopic, or robotic approach. It is technically demanding because scar tissue and distorted anatomy from the original emergency or inflammatory operation can make pelvic dissection difficult.

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What Is Hartmann Reversal?

Hartmann reversal is surgery that restores intestinal continuity after a previous Hartmann procedure. The surgeon closes the end colostomy, frees the remaining colon, and reconnects it to the rectal stump with a colorectal anastomosis. The operation can be performed through an open, laparoscopic, or robotic approach. It is technically demanding because scar tissue and distorted anatomy from the original emergency or inflammatory operation can make pelvic dissection difficult.

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Why Is Hartmann Reversal Performed?

The procedure is performed when a patient with an end colostomy after Hartmann surgery is medically fit and restoration of normal bowel continuity is considered safe and worthwhile. Common original indications include perforated diverticulitis, colorectal cancer, ischemia, trauma, or another emergency colonic condition. Surgeons assess overall health, nutritional status, bowel and rectal-stump condition, pelvic anatomy, prior complications, and the reason for the original surgery before recommending reversal. Some patients keep the colostomy permanently because operative risk, poor rectal function, recurrent disease, or severe adhesions make reversal unsuitable.

How Is Hartmann Reversal Performed?

The surgeon enters the abdomen, divides adhesions, identifies the rectal stump, and mobilizes enough colon to reach the rectum without excessive tension. The colostomy is taken down, and the colon is reconnected to the rectum with a stapled or hand-sewn anastomosis. The connection is checked for blood supply, tension, patency, and leakage before the operation is completed. A temporary diverting ileostomy can be added in selected higher-risk cases, although many reversals do not require another stoma.

What Is Recovery Like After Hartmann Reversal?

Patients are monitored for return of bowel function, pain, infection, anastomotic leakage, urinary problems, and wound healing. Eating and walking are advanced as bowel function returns, and the former colostomy site requires wound care while it closes. Stool frequency, urgency, constipation, or irregular bowel habits can occur while the colon and rectum adapt to restored continuity. Recovery varies widely because adhesions, operative approach, prior disease, and the complexity of the reconnection differ greatly between patients.

What Are the Risks and Complications?

Possible complications include anastomotic leakage, bleeding, infection, bowel obstruction, ileus, blood clots, wound problems, and injury to nearby structures. Dense adhesions can increase operative difficulty and the chance that a minimally invasive procedure must be converted to open surgery. A leak can cause pelvic infection or sepsis and can require drainage, reoperation, or creation of another stoma. Incisional hernia, altered bowel function, or recurrent disease can also affect long-term recovery.

Frequently Asked Questions About Hartmann Reversal

What is reversed during Hartmann reversal?

The end colostomy is closed, and the functioning colon is reconnected to the rectal stump so stool can again pass through the anus.

Can Hartmann reversal be performed laparoscopically or robotically?

Yes. Minimally invasive approaches are used in selected patients, although dense adhesions or difficult pelvic anatomy can require conversion to open surgery.

Does every patient with a Hartmann colostomy have a reversal?

No. Some patients are not suitable candidates because of health risks, poor rectal function, recurrent disease, severe adhesions, or personal preference.

Can another temporary stoma be needed during Hartmann reversal?

Yes. A diverting ileostomy can be created when the new colorectal anastomosis is considered at increased risk for leakage.

References

Ileostomy & Colostomy (Ostomy) Reversal. Cleveland Clinic. https://my.clevelandclinic.org/health/procedures/ostomy-reversal. Date Accessed August 13, 2026.

Hartmann's Reversal: Controversies of a Challenging Operation. PubMed Central (PMC). https://pmc.ncbi.nlm.nih.gov/articles/PMC9668466/. Date Accessed August 13, 2026.

Colostomy Reversal following Hartmann's Procedure: The Importance of Timing in Short- and Long-Term Complications: A Retrospective Multicentric Study. PubMed Central (PMC). https://pmc.ncbi.nlm.nih.gov/articles/PMC9369122/. Date Accessed August 13, 2026.

Conventional and Laparoscopic Reversal of the Hartmann Procedure: a Review of Literature. PubMed Central (PMC). https://pmc.ncbi.nlm.nih.gov/articles/PMC2836249/. Date Accessed August 13, 2026.

Morbidity after reversal of Hartmann operation: retrospective analysis of 56 patients. PubMed Central (PMC). https://pmc.ncbi.nlm.nih.gov/articles/PMC4656958/. Date Accessed August 13, 2026.