Hartmann's Procedure: Why It's Done, Recovery and Reversal
Updated: 6 days ago
Written and medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026 · How we review
Quick Answer: What is Hartmann's procedure?
Hartmann's procedure is an operation that removes a diseased section of the lower colon, seals off the top of the rectum and attaches the healthy colon to an opening in the belly (a colostomy). It is often done in emergencies such as severe diverticulitis, a bowel blockage or colorectal cancer, and it may be reversed after 6 to 12 months. [1]
What the research says
About half of patients get their colostomy reversed. In an audit of 228 people who had Hartmann's procedure, 47% later had a reversal, at a median of 11 months; 21% had a complication after the reversal, and 46% were stoma-free by the end of follow-up. (Hallam et al., Ann R Coll Surg Engl, 2018) [2]
Keyhole surgery may shorten the hospital stay. A meta-analysis of 12 studies found laparoscopic Hartmann's procedure led to a shorter hospital stay and fewer surgical wound infections than open surgery, and single-arm studies reported reversal rates above 80%. (Zhang et al., Int J Colorectal Dis, 2022) [3]
In stable patients, reconnecting the bowel straight away is sometimes an option. A meta-analysis of 12 studies (918 patients) with perforated diverticulitis and widespread peritonitis found that, in stable patients, removing the bowel and reconnecting it in the same operation led to fewer permanent stomas and about one-third fewer major complications after the first operation than Hartmann's procedure. (Ryan et al., Tech Coloproctol, 2020) [4]
Key takeaways
Hartmann's procedure removes the unhealthy lower colon and creates a colostomy, so stool leaves the body through a bag on the belly. [1]
It is often an emergency, life-saving operation for blockage, perforation, recurrent infection or colorectal cancer. [1]
Most people stay in hospital 7 to 10 days and return to routine activities in 4 to 6 weeks. [1]
Surgeons check whether a reversal is safe between 6 and 12 months after the first operation. [1]
What is Hartmann's procedure?
Hartmann's procedure is a type of colectomy (bowel removal surgery) in which a surgeon removes the last part of the colon, called the sigmoid colon, where it joins the rectum. [1] Doctors also call it a proctosigmoidectomy. Sometimes part of the rectum is removed as well. [1]
After the diseased section is taken out, the surgeon performs a colostomy. The healthy end of the colon is brought through an opening in the belly to form a stoma. [1]
Stool then leaves the body through the stoma into a colostomy bag attached to the skin, instead of passing through the anus. [1]
Why is Hartmann's procedure done?
Hartmann's procedure is usually done as an emergency operation to remove a part of the colon that is blocked, torn, repeatedly infected or affected by cancer. [1]
Problem | What happens in the colon |
Blockage | Food, fluid, stool and gas cannot move through normally. [1] See intestinal obstruction. |
Recurrent infection | An infection keeps returning and damages the colon, as in complicated diverticulitis. [1] |
Perforation (a hole in the bowel) | |
Untreated, it can cause a blockage, bleeding or a hole in the colon. [1] |
Why can't the bowel be reconnected during Hartmann's procedure?
The bowel is often not reconnected during Hartmann's procedure because, when the bowel is inflamed, infected or blocked, a new join may not heal and stool could leak into the belly. [1]
Surgeons call this join an anastomosis. In these urgent situations, creating a colostomy is faster and safer than trying to reconnect the colon to the rectum. [1]
What are the benefits and risks of Hartmann's procedure?
The main benefit of Hartmann's procedure is that it saves the healthy part of the colon and lets the digestive tract work as normally as possible while avoiding a risky bowel join. [1]
The operation is considered relatively safe, but complications can happen. [1]
Possible complication | Why it matters |
Blood clots | Can travel to the lungs |
Chest infection (pneumonia) | Can slow recovery |
Damage to nearby organs | May need further treatment |
Hernia | A bulge near the incision or stoma |
Internal bleeding | May need urgent care |
Leaking colon | Can cause infection in the belly, such as peritonitis |
Scarring around the bowel (fibrosis) | Can lead to a later blockage |
Complications listed from [1]; notes in the right-hand column are general explanations.
How do you prepare for Hartmann's procedure?
Preparing for Hartmann's procedure involves fasting for 6 to 12 hours before surgery so your stomach is empty. [1]
You may also do a bowel prep at home to clear out the colon, similar to the prep used before a colonoscopy. [1]
At the hospital, the care team places an IV line for fluids and medicines. You then receive general anesthesia, so you are asleep for the whole operation. [1]
What happens during Hartmann's procedure?
During Hartmann's procedure, the surgeon removes the unhealthy colon, seals the rectal end and creates a stoma, using either a minimally invasive or an open approach. [1]
Minimally invasive (laparoscopic or robotic) | Open surgery | |
Incisions | One small cut for a camera, then a few more small cuts | One large cut in the abdomen |
Typical operating time | Up to about 6 hours | About 3 hours |
Source: [1]
In both approaches, the surgeon follows the same steps: [1]
Finds the part of the colon that needs to be removed.
Removes it and seals off the end that connects to the rectum.
Attaches the healthy colon to the belly wall and makes a new opening (stoma).
Places a colostomy bag over the stoma.
Closes the incisions.
What happens in the hospital after Hartmann's procedure?
After Hartmann's procedure, most people spend a few hours in a recovery room and then 7 to 10 days on a hospital ward. [1]
For the first 3 to 7 days, fluids, antibiotics and pain medicine are given through an IV. [1] You start on a clear liquid diet and slowly move to soft, solid foods. [1]
Nurses also teach you how to care for your stoma and use a colostomy bag. [1]
You are usually ready to go home when your vital signs are stable and you can: [1]
Get up and move around without help
Eat soft, solid food
Pass stool into the colostomy bag
Change and clean the bag yourself
Control pain with tablets taken by mouth
What side effects can happen after Hartmann's procedure?
Short-term side effects after Hartmann's procedure can include a slow-to-wake bowel, discharge from the anus and sexual problems. [1]
Ileus: The bowel can take time to start working again. Until it does, you receive IV fluids and sometimes IV nutrition. [1]
Anal discharge: Fluid left inside the rectum may come out when you use the toilet, mostly within the first week. [1]
Sexual dysfunction: Surgery near the rectum can injure nerves involved in sexual function. Women may notice sensitivity or pain during sex; men may have trouble keeping an erection or ejaculating. [1]
How long does recovery from Hartmann's procedure take?
Recovery from Hartmann's procedure usually takes 4 to 6 weeks for daily activities and 3 to 6 months to feel fully recovered. [1]
Time after surgery | What to expect |
7–10 days | Hospital stay and stoma training |
4–6 weeks | Stop prescription pain medicine, move from a soft to a regular diet, return to exercise or a physically demanding job |
3–6 months | Get used to the colostomy bag, feel physically recovered, possibly start discussing reversal |
6–12 months | Surgeon checks whether you are fit for reversal surgery |
Source: [1]
Can Hartmann's procedure be reversed?
Hartmann's procedure can often be reversed if you heal well and your general health is good. [1]
Your surgeon checks whether you are fit for another operation between 6 and 12 months after the first surgery. [1] During a reversal, the colon is reattached to the remaining rectum and the stoma is closed, so you can pass stool in the usual way again. [1]
Not everyone has a reversal. In one large audit, about half of patients were reversed, and the rest either chose not to or were considered too high-risk for more surgery. [2]
When should you call a doctor after Hartmann's procedure?
You should seek medical attention as soon as possible after Hartmann's procedure if you develop any of these warning signs: [1]
Fever
A lot of blood coming from the stoma
Nausea and vomiting
Severe belly pain, or pain that keeps getting worse
Intense cramps lasting longer than 3 hours
A rash or burning sensation on your skin
What is Hartmann's pouch?
Hartmann's pouch is the name doctors sometimes use for the sealed-off rectum and anus left behind after Hartmann's procedure. [1]
It has no special job of its own. Your care team may refer to it when they monitor that area for infection or disease. [1]
Hartmann's procedure at a glance
Feature | Details |
Other name | Proctosigmoidectomy |
What is removed | The sigmoid colon, and sometimes part of the rectum |
What is created | A colostomy (stoma with a bag) |
Common reasons | Blockage, perforation, recurrent infection, colorectal cancer |
Anesthesia | General |
Operating time | About 3 hours (open) to up to 6 hours (minimally invasive) |
Hospital stay | 7–10 days |
Back to routine | 4–6 weeks |
Reversal check | 6–12 months after surgery |
Source: [1]
Conclusion
Hartmann's procedure is often an urgent, life-saving operation. It removes the diseased lower colon, protects you from a risky bowel join and gives the body time to heal through a temporary colostomy.
Hospital recovery usually takes 7 to 10 days, daily life returns over 4 to 6 weeks and many people can discuss reversal within a year. Knowing the warning signs and asking your surgical team questions early makes recovery safer.
Want to understand the conditions that lead to this surgery? Read our guides to diverticulitis, colon cancer and intestinal obstruction, and share this article with anyone preparing for colon surgery.
FAQ
Is Hartmann's procedure a major surgery?
Yes. Hartmann's procedure is done under general anesthesia, takes about 3 to 6 hours and usually needs a 7 to 10 day hospital stay. It is still considered relatively safe. [1]
Why can't the surgeon reconnect the bowel straight away?
When the bowel is inflamed, infected or blocked, a new join may not heal and stool could leak into the belly. A colostomy is the faster and safer choice in these situations. [1]
How long will I be in hospital after Hartmann's procedure?
Most people stay in hospital for 7 to 10 days. You go home once you can move around, eat soft food, manage your colostomy bag and control pain with tablets. [1]
How long does it take to recover from Hartmann's procedure?
Most people return to daily activities, a regular diet and work in 4 to 6 weeks. Feeling fully recovered and comfortable with the bag can take 3 to 6 months. [1]
Can Hartmann's procedure be reversed?
Yes, if you heal well and your general health is good. Your surgeon checks whether reversal is safe between 6 and 12 months after the first operation. [1]
Will anything come out of my bottom after Hartmann's procedure?
Yes, some fluid left in the rectum can come out when you use the toilet. Most of it passes within the first week. [1]
What is Hartmann's pouch?
Hartmann's pouch is the sealed-off rectum and anus left after the operation. It has no special function, but doctors may monitor it for infection or disease. [1]
When should I seek urgent care after Hartmann's procedure?
Get medical help as soon as possible for fever, heavy bleeding from the stoma, vomiting, severe or worsening belly pain, or cramps lasting longer than 3 hours. [1]
How do I care for my colostomy after Hartmann's procedure?
A stoma nurse will teach you how to empty and change your pouch and protect the skin around the stoma. Call your care team if the stoma turns dark, stops working or the skin around it becomes very sore.
What can I eat after Hartmann's procedure?
Most people start with easy-to-digest foods and add more foods slowly as the bowel recovers. Drink plenty of fluids, and follow your care team's diet advice.
Related Reading
When diverticulitis needs an operation: Diverticulitis Surgery: Types, Procedure, Recovery and Risks
References
Cleveland Clinic. Hartmann’s Procedure: What It Is, Steps & Reversal. Cleveland Clinic. Last updated August 9, 2026. https://my.clevelandclinic.org/health/treatments/21891-hartmanns-procedure
Hallam S, Mothe BS, Tirumulaju R. Hartmann's procedure, reversal and rate of stoma-free survival. Ann R Coll Surg Engl. 2018;100(4):301-307. PMID 29484943. https://doi.org/10.1308/rcsann.2018.0006
Zhang Y, Liu C, Nistala KRY, et al. Open versus laparoscopic Hartmann's procedure: a systematic review and meta-analysis. Int J Colorectal Dis. 2022;37(12):2421-2430. PMID 36416926. https://doi.org/10.1007/s00384-022-04285-6
Ryan OK, Ryan ÉJ, Creavin B, et al. Systematic review and meta-analysis comparing primary resection and anastomosis versus Hartmann's procedure for the management of acute perforated diverticulitis with generalised peritonitis. Tech Coloproctol. 2020;24(6):527-543. PMID 32124112. https://doi.org/10.1007/s10151-020-02172-2
Medical disclaimer
This article is for general education and does not replace advice from your own doctor or surgical team. If you have symptoms or questions about surgery, speak with a qualified healthcare professional. In an emergency, call your local emergency number.
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