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Right Hemicolectomy

Definition:
  • Surgical removal of the cecum, ascending colon, and part of the transverse colon.
Indications:
  • Colon cancer (primarily of the cecum, ascending colon, or right side of the transverse colon).
  • Benign tumors or polyps that can’t be removed via endoscopy.
  • Inflammatory conditions like Crohn’s disease (if localized to the right colon).
  • Trauma to the right colon.
  • Rarely, complications of diverticulitis localized to the right colon.
Surgical Techniques:
  • Open surgery: Large incision on the abdominal wall.
  • Laparoscopic: Minimally invasive with several small incisions; faster recovery.
  • Robot-assisted laparoscopic: Advanced technique with enhanced precision.
Procedure Steps:
  • Ligation of the ileocolic, right colic, and right branch of the middle colic vessels.
  • Dissection and mobilization of the right colon.
  • Transection of the terminal ileum and part of the transverse colon.
  • Anastomosis of the ileum to the remaining transverse colon.
Post-operative Care:
  • Pain management.
  • Mobilisation to prevent thromboembolic complications.
  • Gradual reintroduction of diet.
  • Appropriate VTE (typically TED stockings and pharmacological prophylaxis (dalteparin or enoxaparin)
  • Monitor bowel movements and passage of flatus.
  • Monitor for signs of anastomotic leak (e.g., fever, increased abdominal pain, leukocytosis).
Complications:
  • Anastomotic leak.
  • Infection.
  • Ileus or bowel obstruction.
  • Hemorrhage.
  • Injury to nearby structures (e.g., ureter).
  • Thromboembolic events.
  • Adhesions leading to chronic pain or obstruction.
Additional reading

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