Editing Hartmann's procedure (section)

== Technique ==

* Lithotomy with myself on     patient's right
* Typically full laparotomy
* Explore abdomen
* Pack small bowel to RUQ
* Mobilise descending colon -     lateral to medial, along white line of Toldt
** Identify and preserve ureter      early, along with gonadal vessels. Close colonic dissection to avoid it,      and expect to encounter it just medial to gonadal vessels.
** Lift sigmoid vertically and      identify IMA pedicle medially, then join lateral and medial dissection      planes
** Identify and divide vessels      high, especially if disease is malignant
** Identify point of division      (healthy descending colon) and carry mesenteric dissection up to this      point
* Carry that dissection down to     upper rectum
** Leave rectal stump as long      as possible to facilitate reversal
* Staple across the rectum     (contour or EndoGIA)
** Mark stump with Prolene tags
** Consider bringing stump out      as mucus fistula
* Usually don't need to     mobilise splenic flexure - only proximal mobilisation if needed to bring     out a stoma
* Create stoma (see separate     topic)
* Close wound
* Suture stoma in place