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Hartmann’s reversal - the stoma out, properly.

Reconnection of the colon to the rectal stump after a Hartmann’s procedure - laparoscopically where anatomy allows, open where safer. A consultant colorectal surgeon, contrast imaging of the stump, ERAS recovery and a stoma nurse on your case from day one.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What a private Hartmann’s reversal costs in the UK.

Indicative ranges across our colorectal network.

In short

£13,000–£20,000, home 3–5 nights.

Procedure Indicative range
Laparoscopic Hartmann’s reversal £13,000–£20,000
Open Hartmann’s reversal £12,000–£18,000
Reversal with protective loop ileostomy £14,000–£22,000
Complex reversal (dense adhesions, ventral hernia repair) £18,000–£28,000
Contrast enema of rectal stump £350–£650
CT abdomen and pelvis (planning) £450–£900
Colorectal consultation only £280–£500

Prices vary by hospital, by the surgeon, by whether a protective ileostomy is added and by whether a ventral hernia is repaired at the same sitting. Complex adhesion cases and combined hernia work sit at the top.

The problem

Timing, imaging, and honest patient selection.

Hartmann’s reversal is where general colorectal lists quietly under-deliver - reversal offered on autopilot, adhesions found intra-operatively, and anastomotic leaks that could have been prevented.

  • Wait long enough, not too long

    Most surgeons prefer 3–6 months from the index Hartmann’s. Sooner risks unresolved inflammation; later risks profound adhesions.

  • Image the stump before booking

    A contrast enema and CT prevent aborted operations and identify strictured or too-short stumps that need a different plan.

  • Some patients are safer with a permanent stoma

    Frail, low-albumin, poor pelvic anatomy or persistent sepsis - reversal risks may outweigh benefit. We say so if it fits you.

When it helps

When reversing a Hartmann’s is the right step.

The situations we see most, plus the finding that must be sorted before theatre - not on the table.

  • End colostomy after perforated diverticulitis

    The classic indication - recovery complete, pelvic sepsis resolved, patient fit and motivated for reversal.

  • End colostomy after obstructing cancer

    Reconnection after oncological resection is safe once cancer surveillance is up to date and adjuvant treatment is complete.

  • End colostomy after ischaemic colitis

    Once vascular optimisation and healing are confirmed, reversal is realistic - sometimes with a covering ileostomy.

  • End colostomy after iatrogenic injury

    Reversal after inadvertent colonic injury during gynaecology, urology or laparoscopic surgery - often laparoscopic if adhesions allow.

  • Coexisting incisional hernia

    Ventral or parastomal hernia repaired at the same sitting - mesh choice discussed carefully in a contaminated field.

  • Quality-of-life-driven reversal

    Bag-related dermatitis, leakage, sexual concerns and social withdrawal - legitimate drivers of a well-informed decision.

  • Younger patient after trauma

    A previously well person after penetrating trauma - often the best candidate for laparoscopic reversal.

  • Red flag: ongoing pelvic sepsis or unresolved cancer

    A collection on CT, raised CRP, or incomplete oncological staging must be sorted before theatre - not discovered on the table.

Procedure options

The approach depends on the abdomen you are opening.

What each option involves - approach, protective stoma and hernia work - and when each earns its place.

  • Laparoscopic Hartmann’s reversal

    Preferred where the abdomen and pelvis allow. Small ports, careful adhesiolysis, mobilisation of the descending colon, stapled colorectal anastomosis. Faster recovery, less pain, fewer wound complications.

  • Open Hartmann’s reversal

    Laparotomy where dense adhesions, prior open surgery, complex hernia or a hostile pelvis make laparoscopic unsafe. Higher wound morbidity but sometimes the safer choice.

  • Robotic reversal

    Selected units use robotic platforms for improved dexterity in the deep pelvis - outcomes broadly comparable to laparoscopic in experienced hands.

  • Reversal with protective loop ileostomy

    A temporary ileostomy protects a high-risk anastomosis (low, tension, poor blood supply, prior radiotherapy) - closed 8–12 weeks later.

  • Hand-assisted laparoscopic

    A small hand-port allows tactile feedback in bulky or scarred abdomens - a middle option between fully laparoscopic and open.

  • Combined ventral hernia repair

    Incisional hernias are common after Hartmann’s. Repair at the same sitting is often best, with careful mesh choice given the contaminated field.

  • Parastomal hernia repair

    Repaired at the time of stoma reversal - the fascial defect is closed with or without mesh depending on size and contamination risk.

  • Abandonment on the table

    Occasionally intra-operative findings mean reversal is unsafe. A frank pre-operative discussion of this possibility is standard.

Safety and recovery

What to expect afterwards - honestly.

Hartmann’s reversal is well established but carries meaningful complication rates. Patient selection, imaging and ERAS matter more than any single technique choice.

  • GA and enhanced recovery

    Every case is under GA. ERAS - early feeding, mobilisation, no NG tube - is the default and shortens length of stay.

  • Anastomotic leak is the big risk

    Colorectal anastomotic leak rate 4–12 percent after Hartmann’s reversal - mitigated by good technique, tension-free anastomosis, air leak testing and, where high risk, a protective ileostomy.

  • Wound infection and hernia

    Wound infection 10–20 percent open, 5–8 percent laparoscopic. Incisional hernia risk 15–25 percent long-term.

  • Bleeding, ureter and bowel injury

    Bleeding, ureteric or small bowel injury each occur in under 2 percent - recognised and managed on the table by an experienced team.

  • Low anterior resection syndrome (LARS)

    Urgency, frequency and clustering after low anastomoses is common early on - most improves over 6–12 months, some persists and needs dedicated bowel rehabilitation.

  • Sexual and bladder function

    Pelvic dissection can rarely disturb autonomic nerves - discussed pre-operatively, particularly in men.

  • DVT and PE

    Standard prophylaxis - stockings, heparin, early mobilisation - reduces risk to below 2 percent.

  • Reversal is not always possible

    Around 5–10 percent of planned reversals are abandoned intra-operatively due to hostile pelvis or short rectal stump. This is discussed before consent.

  • Red flags after surgery

    Fever, worsening abdominal pain, tachycardia, no return of bowel function or new pelvic pain after day 3 need the same-day team - anastomotic leak until proven otherwise.

Reading your operation note

Your operation note in four parts. Read the last one first.

Whichever approach was used - laparoscopic, robotic or open - the note the colorectal surgeon sends you keeps to the same shape.

A UK consultant colorectal surgeon reviewing a patient’s operation notes

A quiet reminder

Clinical language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the notes and any results before your review, just ask.

  1. 01 Header

    Approach, extent and stoma status

    Laparoscopic, open or robotic; whether a protective ileostomy was added; and whether a hernia was repaired.

  2. 02 Technique

    Anastomosis and adjuncts

    Stapled or hand-sewn colorectal anastomosis, air leak test result, any bowel resection or hernia repair, drains left in situ.

  3. 03 Findings

    Adhesions, pelvis, and any surprises

    What the pelvis and abdomen looked like - adhesions, hostile pelvis, other pathology found - and how it changed the plan.

  4. 04 Impression

    ERAS plan and follow-up

    Read this first: feeding plan, when to expect bowel function, discharge criteria, and follow-up dates including stoma closure if planned.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Reversal of Hartmann’s procedure is usually covered when medically indicated. Combined ventral hernia repair is usually covered too, subject to pre-authorisation.

Frequently asked

Everything we get asked about Hartmann’s reversal.

Quick answers on timing, technique, leak risk, function and cost.

  • When should a Hartmann’s procedure be reversed?

    Usually 3–6 months after the index operation - long enough for inflammation to settle and nutrition to recover, short enough to avoid the very dense adhesions of the 12-month-plus stump. Timing is individual and depends on comorbidity, healing and any cancer treatment.

  • Will my operation be laparoscopic or open?

    Laparoscopic where the abdomen and pelvis allow - around 40–60 percent of cases in high-volume units. Dense adhesions, prior multiple laparotomies, ventral hernia or a hostile pelvis push toward open. The decision is made after imaging and often refined at the start of surgery.

  • What is the risk of an anastomotic leak?

    Colorectal anastomotic leak after Hartmann’s reversal is 4–12 percent. It is the single most important complication. Mitigating factors - tension-free anastomosis, good blood supply, air leak testing and a protective ileostomy in high-risk cases - reduce risk but do not eliminate it.

  • Will I need another stoma?

    Sometimes. A temporary loop ileostomy is added in a minority of higher-risk cases and closed 8–12 weeks later. Occasionally intra-operative findings mean reversal is unsafe and the end colostomy is refashioned. This possibility is discussed at consent.

  • What will my bowel function be like afterwards?

    Most people have some urgency, frequency and clustering in the first weeks - low anterior resection syndrome. Function usually improves substantially by 6 months and continues to settle over the first year. Persistent difficulty responds well to structured bowel rehabilitation.

  • How much does a private Hartmann’s reversal cost in the UK?

    Roughly £13,000–£20,000 for laparoscopic, £12,000–£18,000 for open, £14,000–£22,000 with a protective loop ileostomy, and £18,000–£28,000 for complex cases with ventral hernia repair.

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