From the Guidelines
A right hemicolectomy involves several key operative steps, including mobilization of the right colon, vascular control, and restoration of intestinal continuity with an ileocolic anastomosis, as recommended by the most recent guidelines 1. The procedure begins with appropriate patient positioning, typically supine, followed by abdominal access either through laparoscopic ports or an open midline or right transverse incision. After entering the peritoneal cavity, the surgeon performs a thorough exploration to assess for metastatic disease or other pathology. The right colon is then mobilized by incising along the white line of Toldt and reflecting the right colon medially, carefully preserving the ureter and duodenum. The hepatic flexure is taken down by dividing the hepatocolic ligament. Vascular control is achieved by identifying, ligating, and dividing the ileocolic, right colic, and right branch of middle colic vessels at their origin from the superior mesenteric vessels. The terminal ileum is divided approximately 5-10 cm proximal to the ileocecal valve, and the transverse colon is divided at an appropriate point, usually just past the middle colic vessels. After specimen removal, intestinal continuity is restored with an ileocolic anastomosis, either using a stapled or hand-sewn technique, as supported by the guidelines 1. Hemostasis is confirmed, the anastomosis is checked for integrity, and the abdomen is closed in layers. This procedure removes the cecum, ascending colon, hepatic flexure, and proximal transverse colon along with associated lymphatic drainage, making it effective for treating right-sided colon cancers, large polyps, inflammatory conditions, or ischemic segments in this region, with consideration of the patient's overall condition and the potential need for additional procedures, such as a terminal ileostomy, as noted in the guidelines 1.
Some key points to consider during the procedure include:
- The importance of preserving the ureter and duodenum during mobilization of the right colon 1
- The need for thorough exploration of the peritoneal cavity to assess for metastatic disease or other pathology 1
- The use of vascular control to prevent bleeding and ensure safe division of the ileocolic, right colic, and right branch of middle colic vessels 1
- The consideration of the patient's overall condition and the potential need for additional procedures, such as a terminal ileostomy, in cases of poor general or adverse local conditions 1
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Operative Steps for Right Hemicolectomy
The operative steps for a right hemicolectomy involve several key procedures, including:
- Incision: The type of abdominal incision used can vary, with studies suggesting that a transverse incision may be preferable to a midline incision due to reduced post-operative pain and faster recovery of pulmonary function 2, 3.
- Resection: The right colon and a portion of the terminal ileum are resected, along with the corresponding mesentery 4.
- Lymph node dissection: A complete mesocolic excision (CME) is often performed to ensure adequate lymph node yield and improve oncological outcomes 4.
- Anastomosis: The ileocolic anastomosis can be created using a stapled end-to-side, stapled side-to-side, or handsewn technique, with no significant difference in rates of anastomotic leak and bleeding between techniques 5.
Considerations for Operative Technique
When performing a right hemicolectomy, several factors should be considered, including:
- The type of incision used, with transverse incisions potentially offering benefits in terms of reduced post-operative pain and faster recovery 2, 3.
- The extent of lymph node dissection, with CME potentially improving oncological outcomes 4.
- The technique used for anastomosis, with stapled end-to-side anastomosis potentially resulting in lower rates of post-operative ileus 5.
Post-Operative Care and Complications
Post-operative care and complications should also be considered, including: