In an obstructed colonic carcinoma at the sigmoid colon with proximal bowel dilation, the Hartmann procedure is performed as an emergency. Six months later, the patient is fit for re-anastomosis. What is the term for the reverse Hartmann procedure?

• A Anterior resection
• B Left hemicolectomy
• C Paul-Mikulicz procedure
• D Hartmann's reversal (Hartmann's reconnection) ✓

Explanation

Hartmann's reversal (or reversal of Hartmann's procedure) refers to the re-establishment of bowel continuity after a previous Hartmann operation, where the colostomy is taken down and a colorectal anastomosis is created between the proximal colon and the rectal stump. This is technically challenging due to adhesions and requires careful mobilization of the rectal stump and splenic flexure. The Paul-Mikulicz procedure is a different historical technique (double-barreled colostomy). Anterior resection is for primary sigmoid/rectal cancer resection.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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