The procedure is typically performed in emergencies, tailored to the patient’s condition and extent of disease:

1. Before Procedure Evaluation:
   
   • Diagnosis is confirmed via:
     
     • CT scan: Identifies perforation, abscess, or obstruction, showing free air or fluid in the abdomen.
     • X-ray: Detects pneumoperitoneum (free air) in perforation cases.
     • Blood tests: Assess infection (elevated white cell count), sepsis, or organ function.
   • Patients are stabilized with IV fluids, broad-spectrum antibiotics (e.g., ceftriaxone, metronidazole), and pain management.
   • Bowel preparation is usually avoided due to the emergency nature, but a nasogastric tube may decompress the stomach.
   • An enterostomal therapist marks the stoma site pre-surgery, if possible.
2. Surgical Technique:
   
   • Open Hartmann’s Procedure:
     
     • Performed under general anesthesia, lasting 2–4 hours.
     • A midline abdominal incision provides access to the peritoneal cavity.
     • The surgeon:
       
       • Resects the diseased colon segment (e.g., sigmoid colon for diverticulitis).
       • Closes the distal rectal stump (left in place) with sutures or staples to prevent leakage.
       • Creates an end colostomy by bringing the proximal colon through the abdominal wall to form a stoma, where a colostomy bag collects stool.
       • Performs peritoneal lavage to clean contamination from perforation or abscesses.
     • Drains may be placed to manage residual fluid or infection.
   • Laparoscopic Hartmann’s Procedure:
     
     • A minimally invasive approach using 3–5 small incisions, a laparoscope (camera), and specialized instruments.
     • Suitable for stable patients with less severe contamination (e.g., early perforation), offering less pain and faster recovery.
     • Takes 2–3 hours, with conversion to open surgery possible if complications arise.
   • Robotic-Assisted Hartmann’s Procedure:
     
     • Rare, but used in select centers (e.g., Apollo, Medanta) for enhanced precision, particularly in complex cases.
     • More expensive due to advanced technology.
3. After Procedure:
   
   • Patients are monitored in the ICU for 1–3 days to manage sepsis, pain, and stoma function.
   • Hospital stay lasts 5–10 days for open surgery or 3–7 days for laparoscopic surgery.
   • Antibiotics continue for 5–7 days or longer for severe infections.
   • An enterostomal therapist trains patients on colostomy care, including bag changes and skin protection.
   • Pathology reports guide further treatment (e.g., chemotherapy for cancer).