Special Conditions

Avoiding temporary colostomies such as Hartman’s operations

Hartman’s operation is done in patients with intact rectum and sphincter apparatus to exclude feces from passing though colon that has been repaired after perforation mostly from diverticular disease. A second operation is usually necessary at a later point to take down the colostomy. Mortality of taking down colostomy has been reported to be up to 4% in critical studies. The reason to do a Hartman is fear that a colon anastomoses fabricated in presence of peritonitis may leak and surgeon have been taught for many generations that a Hartman with a protective colostomy is safe.

Patients do not like colostomies. With the introduction of the bur closure suturing of anastomoses become safe as it is possible to observe healing at subsequent STAR's and to correct problems if necessary. Patients avoid the experience of having stool coming out of the abdominal wall and they do not require a second hospitalization for take down of the colostomy.

Relevant Cases

• Colostomy takedown after repair of intestinal leaks
• Diffuse peritonitis from anastomotic leaks

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Lengthy abdominal operations with fragile anastomoses

Lengthy abdominal operations expose the peritoneum to air and prolonged manipulations. The peritoneum responds with edema which may lead to abdominal hypertension after fascial closure. If there are areas such as anastomoses with critical perfusion the elevated abdominal pressure may compromise blood supply and induce anastomotic leaks.

Closure with the help of the artificial bur (Wittmann Hypopack™) may circumvent these complications.