Rectal resection according to Hartmann

Marking of the planned stoma, which should be placed in the outer third of the rectus muscle on the line between the spine and the navel.
Midline laparotomy. Insertion of a ring drape and a self-retaining retractor.
Thorough exploration of the entire abdomen and exclusion of extrahepatic metastases.

The colon is pulled medially and the lateral adhesions with the peritoneum lateral to the abdominal wall are sharply dissected.

Pre-aortic dissection after opening the retroperitoneum and central transection of the inferior mesenteric artery under ligatures (central piercing) while preserving the superior hypogastric plexus.

Mobilization of the descending-sigmoid junction. Transection of the mesosigmoid up to the centrally ligated artery. Resection of the oral margin with a GIA stapler.

Incision of the pelvic floor peritoneum with the electric knife. Excision and detachment of the mesorectum from the presacral fascia. Visualization of the left ureter. The presacral area is then prepared up to the puborectal sling, as well as ventrally and finally laterally.

Resection of the rectum above the muscular pelvic floor using an articulating Endo-GIA (in this example, two 45 mm cartridges are necessary) or a curved stapling device (e.g., Contour stapler). Check the cut specimen for an adequate safety margin.

Tip: For a short Hartmann's stump, perform a digital check for tightness.