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Right Hemicolectomy

Background Knowledge šŸ§ 

Definition

Surgical removal of the caecum, ascending colon, and part of the transverse colon.

Indications

  • Colon cancer (primarily of the caecum, ascending colon, or right side of the transverse colon).
  • Benign tumours or polyps that can’t be removed via endoscopy.
  • Inflammatory conditions like Crohn’s disease (if localised to the right colon).
  • Trauma to the right colon.
  • Rarely, complications of diverticulitis localised 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

  1. Ligation of the ileocolic, right colic, and right branch of the middle colic vessels.
  2. Dissection and mobilisation of the right colon.
  3. Transection of the terminal ileum and part of the transverse colon.
  4. Anastomosis of the ileum to the remaining transverse colon.

Management šŸ„¼

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.
  • Haemorrhage.
  • Injury to nearby structures (e.g., ureter).
  • Thromboembolic events.
  • Adhesions leading to chronic pain or obstruction.

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