From the Guidelines
A hemicolectomy, also known as a partial colectomy, is a surgical procedure that involves removing a portion of the colon, typically performed to treat conditions such as colon cancer, inflammatory bowel disease, or diverticulitis, and is generally favored whenever feasible, as it does not increase the risk of recurrence, particularly in the modern era of biologics 1.
Definition and Purpose
A hemicolectomy is a surgical operation that involves the removal of a part of the colon, which is the large intestine. This procedure is usually performed to treat various conditions, including colon cancer, large polyps, inflammatory bowel disease (such as Crohn's disease), or diverticulitis. The goal of the surgery is to remove the diseased portion of the colon and then reconnect the remaining healthy parts to restore normal intestinal function.
Surgical Procedure
During a hemicolectomy, the surgeon removes either the right or left side of the colon, along with nearby lymph nodes, and then reconnects the remaining healthy portions of the colon. The surgery can be performed using traditional open surgery or modern minimally invasive techniques, such as laparoscopic or robotic-assisted surgery. These minimally invasive approaches often result in smaller incisions, less pain, and faster recovery times compared to traditional open surgery.
Post-Operative Care and Recovery
Recovery from a hemicolectomy typically takes 4-6 weeks, with patients usually staying in the hospital for 3-7 days after surgery. Initially, patients receive intravenous fluids and pain medication, gradually transitioning to a clear liquid diet and then to solid foods as bowel function returns. Common post-operative care includes early ambulation, deep breathing exercises, and progressive dietary advancement. Potential complications include infection, bleeding, anastomotic leak, and bowel obstruction.
Recent Guidelines and Recommendations
According to recent guidelines, segmental colectomy, which is a type of hemicolectomy, is generally favored whenever feasible, as it does not increase the risk of recurrence, particularly in the modern era of biologics 1. A recent meta-analysis included patients who underwent segmental colectomy, subtotal colectomy, or total proctocolectomy, and found that segmental colectomy resulted in fewer patients requiring permanent stoma, although it had higher rates of complications compared to subtotal colectomy 1. However, the decision to perform a hemicolectomy should be individualized based on the patient's specific condition, the extent of disease, and other factors, as determined by the clinical presentation and the number of colonic segments involved 1.
Key Considerations
Some key considerations for patients undergoing hemicolectomy include:
- The extent of colonic resection is determined by the clinical presentation and the number of colonic segments involved 1
- Segmental colectomy is generally favored whenever feasible, as it does not increase the risk of recurrence, particularly in the modern era of biologics 1
- The decision to create a stoma should be individualized based on the patient's specific condition and the extent of disease 1
- Follow-up care typically includes regular check-ups to monitor healing and, in cancer cases, surveillance for recurrence.
From the Research
Definition of Hemicolectomy
- A hemicolectomy, also known as a partial colectomy, is a surgical procedure that involves the removal of a portion of the colon 2.
- The procedure can be performed on either the left or right half of the colon, depending on the location of the disease or condition being treated 2.
Indications for Hemicolectomy
- Hemicolectomy is often performed to treat various conditions, including:
- Tumors of the colon
- Colon polyps
- Complicated diverticular disease
- Inflammatory bowel disease (such as Crohn's disease or ulcerative colitis) 2
Surgical Techniques
- Hemicolectomy can be performed using various surgical techniques, including:
Outcomes and Complications
- Studies have shown that hemicolectomy can be safely performed with acceptable morbidity and mortality rates 3, 4, 6, 5.
- Common complications include wound infection, bleeding, and bowel obstruction 3, 4, 6, 5.
- The learning curve for single-port laparoscopic right hemicolectomy is relatively short, requiring approximately 10 cases to decrease operative times to baseline 5.