To the Editor.—In a short two-paragraph report, Hartmann1 suggested abdominal proctosigmoidectomy for the treatment of cancers of the terminal portion of the pelvic colon. By closing the distal stump and omitting the perineal dissection he obtained "postoperative courses... as uneventful as those of an operation for an uninflamed appendix." He also stated, "The preservation of a small sub-sphincteric rectal pouch did not cause the slightest inconvenience."
We doubt that thorough en bloc excision of the primary tumor as well as its regional lymphatic spread can be accomplished by this method, but have found that it provides excellent palliation for advanced lesions. Removal of the primary lesion stops fluid and nitrogen loss from mucoid discharges and avoids obstructive symptoms. For the first reason it is to be preferred to a simple loop colostomy, especially because it can be done with as little risk.
The Hartmann procedure was performed by
FERARU F, SHEIN S, FREEMAN H. Palliation of Advanced Carcinomas of the Lower Sigmoid Colon and Rectum. Arch Surg. 1973;106(1):115. doi:10.1001/archsurg.1973.01350130109027