Reversal of Hartmann's procedure

The main benefit of a reversal of Hartmann's procedure is that you will no longer have a stoma and you will be able to open your bowels in the normal way.

Call or book online today to arrange a consultation to discuss a private reversal of Hartmann's procedure with a consultant of your choice at Circle Health Group.

At your first consultation, you will usually be seen by a consultant gastroenterologist, a doctor specialising in conditions affecting the digestive system. They will ask you about your general health and medical history and perform a physical examination. They will discuss the risks and benefits of a reversal of Hartmann's procedure and why you want to have the operation.

At Circle Health Group, your first appointment is important as it's where we get to know you, discuss your expectations for treatment and encourage you to ask any questions you may have. It is important to us that you are as well-informed and comfortable as possible before, during, and after your surgery, so please discuss any questions or concerns with your consultant during your appointment.

At the end of your appointment, your consultant will decide if a reversal of Hartmann's procedure is suitable for you. They will explain the procedure to you including what happens during the procedure, all the potential risks and complications, and what to expect during your recovery.

Your consultant will tell you everything you need to do to prepare for your surgery. If there's anything you're not sure about, or if you have any questions about how to prepare for your surgery, speak to your consultant or call the hospital for advice. Being well-prepared for your surgery will help to ease any anxiety you may have as well as allow your surgery and recovery to go more smoothly.

Before your surgery, tell your consultant about any medical conditions or allergies you have and any medication you are taking, including over-the-counter medicines. Your consultant may tell you to stop taking some medications like blood thinners before your operation. This is to reduce the risk of bleeding during and after your surgery.

Before your operation, you will need to have a preoperative assessment to check that you are fit for surgery. This will include a blood test, chest X-ray and ECG and is normally done around a week before your surgery.

Your bowel will need to be empty before your reversal of Hartmann's procedure. Your consultant will give you instructions on how to prepare your bowel for surgery before your operation. You will not be able to eat or drink anything from midnight on the day of your surgery.

What lifestyle changes can I make before my surgery?

It's important to be in the best possible health before your surgery as this will reduce the risk of complications and speed up your recovery.

To make sure you are as healthy as possible before your surgery:

• Eat a healthy, balanced diet with plenty of fruit, vegetables, lean proteins, and whole grains
• If you smoke, try to stop at least eight weeks before your surgery
• Avoid alcohol for a few days before and after your surgery. Alcohol thins the blood and can increase the risk of bleeding
• Take regular exercise

Reversal of Hartmann's procedure is performed under general anaesthetic which means you'll be asleep during your surgery and won't feel any pain.

The operation can either be performed as open surgery or as laparoscopic (keyhole) surgery. Your consultant will decide which type of surgery is right for you based on your individual circumstances.

Open surgery

During open surgery, your consultant will make an incision (cut) of around 20 cm along the middle of your abdomen, normally along the same scar as the original operation.

Your consultant will free up the ends of your bowel and join the two ends together to form an anastomosis. They will then place your joined bowel back inside your abdomen. The incision is then closed with surgical glue, stitches, or staples.

Laparoscopic surgery

Keyhole reversal of Hartmann's surgery is performed through small incisions in the abdomen using a device called a laparoscope, which is a small flexible tube with a camera and light at the end. This transmits images from inside your abdomen onto a screen so that your surgeon can see what they are doing, and they'll insert small surgical instruments through further small incisions to perform the procedure.

Laparoscopic surgery is less invasive than open surgery and has a lower risk of complications and normally a faster recovery time. In some cases, it may not be possible to continue to perform the surgery laparoscopically and your consultant may need to proceed to open surgery.

Reversal of Hartmann's procedure normally takes between 90 minutes and three hours.

Recovery from any type of surgery is different for everyone and depends on factors such as your age, general health and whether or not there were any complications during your operation. Your consultant will be able to give you an estimated recovery timeline based on your individual circumstances.

After your surgery, you will be taken to the recovery room where your breathing, heart rate and blood pressure will be monitored closely until the effects of the anaesthetic have worn off. You will then be taken to your room.

When you wake up from the anaesthetic, you will have a urinary catheter in place to drain urine from your bladder. You may also have one or two drains in your lower abdomen to drain fluids after your surgery. These will be removed after a few days.

You will need to wear elastic stockings to prevent blood clots from developing in your legs after your operation. You will be encouraged to get up, sit in a chair and take short walks the day after your surgery.

Your healthcare team will give you regular painkillers to manage any postoperative pain after your surgery. Please tell a member of the nursing staff if you have any pain or discomfort after your operation.

You will be able to drink fluids shortly after your operation and should be able to eat normally after around two to three days. Your bowel will probably take a few days to start working again after your surgery. You will probably hear bowel sounds after around two to three days and have a bowel movement after three to four days, although this may take longer. Passing wind is normally the first sign that your bowels are working again. You may experience a change in your bowel movements such as urgency, passing stools more or less frequently and a change in the colour or consistency of your stool. This normally settles down over time.

How many nights will I need to stay in hospital?

Most people spend between five and 10 days in hospital after a reversal of Hartmann's procedure.

Will I be able to drive home?

You will not be able to drive yourself home from the hospital after your reversal of Hartmann's procedure. Please make arrangements for someone to come and collect you when you are discharged. You will need someone to help with activities like cooking, shopping, and housework for the first week or so after your surgery.

How soon can I go back to work?

How soon you can go back to work after your surgery depends on the type of surgery you had, your individual recovery, and the kind of job you do. If your job is sedentary, such as office work, you can probably return within two to three weeks, but if your job is strenuous or requires heavy lifting you may need to take at least six weeks off work. Recovery is normally faster after laparoscopic surgery than after open surgery.

How soon can I drive?

You should not drive until you can wear a seatbelt without pain and perform an emergency stop comfortably. This is normally around two to three weeks after your surgery. Check with your consultant and inform your insurance company before driving after your operation.

When will I be back to normal?

Recovery from any surgery is a gradual process that is different for everyone. You can help your recovery to go more smoothly by taking things at your own pace and listening to your body. Follow your consultant's instructions carefully and be sure to keep any follow-up appointments. Call the hospital if you have any questions or concerns.

You will probably feel quite tired for the first few weeks after your operation. Build up your activity level slowly and allow yourself time to rest when you need to. Gentle exercise like walking every day will help build muscle strength and avoid problems with your circulation.

Avoid heavy lifting including shopping, laundry and small children, and strenuous activity for the first six weeks after your surgery.

Most people resume normal activities after around three weeks, but it can take up to three months to fully recover from a reversal of Hartmann's procedure.

Like all surgical procedures, a reversal of Hartmann's procedure carries a risk of complications. Your consultant will explain all the possible risks and complications before your surgery and answer any questions you have about your procedure. Being as well-informed as possible about what to expect from your surgery will help put your mind at rest and allow you to make an informed decision so please ask any questions you may have.

Possible complications of any surgery include:

• Bleeding
• Infection
• Blood clots
• Chest infection
• Adverse reactions to the anaesthetic

Possible complications specific to a reversal of Hartmann's procedure include:

• Leakage of the anastomosis (where the bowel was joined during surgery)
• Ileus - this occurs when the bowel stops working after surgery and needs to be rested until it is functioning again
• Bowel obstruction - the bowel may become blocked by scar tissue (adhesions) in the months after surgery. This is treated with further surgery
• Temporary ileostomy - a temporary ileostomy may be formed to allow the anastomosis to heal. This will be reversed in a later operation
• Incisional hernia
• Damage to surrounding structures like tissues, organs, or blood vessels

Call your doctor straight away if you experience any of the following after your surgery:

• Green, yellow, or strong-smelling discharge from your surgical wound
• Fever (a temperature above 38C)
• Pain when urinating, urinating frequently, or strong-smelling urine
• Pain in your chest or lower leg
• Difficulty breathing
• Cough with yellow or green phlegm
• Bleeding from your bottom
• Vomiting
• Abdominal pain

At Circle Health Group, we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about reversal of Hartmann’s procedure, book your appointment online today or call a member of our team directly.

Content reviewed by Circle in-house team in April 2023. Next review due April 2026.

1. Reversal of Hartmann’s procedure, Milton Keynes University Hospital NHS Foundation Trust
2. Hartmann’s procedure, reversal, and rate of stoma-free survival, PubMed
3. Laparoscopic Hartmann Procedure Reversal, Medscape
4. Hartmann's reversal: factors affecting complications and outcomes, PubMed