A right hemicolectomy is a surgical procedure that removes a section of the large intestine, specifically the right side of the colon. The goal of this surgery is to remove diseased or damaged tissue from this region. It is a type of colectomy, which refers to any operation that removes a part of the colon.
Understanding the Procedure
A right hemicolectomy involves removing the right portion of the large intestine, typically about one-third of its total length. This section includes the cecum, which is the beginning of the large intestine, and the appendix, a small finger-shaped organ attached to the cecum. The ascending colon, which travels upwards on the right side of the abdomen, is also removed. Additionally, the hepatic flexure, which is the bend where the ascending colon meets the transverse colon, and sometimes a portion of the transverse colon itself are resected.
The large intestine absorbs water and electrolytes from digested food and forms stool. During a right hemicolectomy, the terminal ileum, the last part of the small intestine, is also removed. After the diseased section is removed, the remaining healthy end of the small intestine is reconnected to the remaining healthy part of the large intestine, typically the transverse colon. This reconnection is known as an anastomosis.
Reasons for Surgery
Right hemicolectomy is commonly performed to address various medical conditions affecting the right side of the colon. The most frequent reason for this surgery is colon cancer, particularly tumors located in the cecum, ascending colon, or hepatic flexure. The operation aims to remove the cancerous tissue along with surrounding healthy margins and associated lymph nodes to prevent the spread of the disease. Removing the diseased area provides information about the cancer’s stage, which guides further treatment if necessary.
The procedure is also indicated for certain benign conditions. Inflammatory bowel diseases, such as Crohn’s disease, can severely affect the ileocecal region, necessitating surgical removal when medical treatments are insufficient or complications arise. Severe diverticular disease can also lead to the need for a right hemicolectomy. Large or abnormal polyps that cannot be safely removed through endoscopic procedures may require surgical resection. Other less common indications include cecal volvulus and severe appendicitis with involvement of the cecum.
The Surgical Process
A right hemicolectomy can be performed using two main surgical approaches: open surgery or laparoscopic (minimally invasive) surgery. In open surgery, the surgeon makes a single, longer incision in the abdomen to access the colon directly. Laparoscopic surgery involves several smaller incisions through which specialized instruments and a camera are inserted. A slightly larger incision is then made to remove the resected bowel segment.
The choice between open and laparoscopic surgery depends on factors specific to the patient and the surgeon’s assessment. Laparoscopic procedures are generally associated with faster recovery times and smaller scars, but sometimes a laparoscopic procedure may need to be converted to an open surgery if difficulties arise.
Regardless of the approach, the fundamental steps involve carefully mobilizing the right colon, which includes detaching it from surrounding tissues. The blood vessels supplying the affected section, such as the ileocolic and right colic arteries, are carefully tied off and divided. The diseased segment of the colon, along with the terminal ileum, is then resected. Finally, the remaining healthy ends of the small intestine and colon are rejoined, typically using sutures or surgical staples, to restore the continuity of the digestive tract. This allows normal bowel function to resume.
Recovery and Post-Operative Care
Following a right hemicolectomy, patients typically spend several days in the hospital for initial recovery and monitoring. Pain management is an important aspect of immediate post-operative care, often managed with intravenous or oral medications. Early mobilization, such as getting out of bed and walking shortly after surgery, is encouraged to aid recovery and prevent complications. The diet is gradually advanced, starting with clear liquids and progressing to solid foods as bowel function returns.
Once discharged from the hospital, the recovery period continues at home, usually lasting several weeks. Patients are advised to limit strenuous activities, heavy lifting, and abdominal strain for a period, typically four to six weeks, to allow the surgical site to heal properly. Wound care involves keeping the incision clean and dry to prevent infection. Follow-up appointments with the surgeon are scheduled to monitor healing and discuss any further treatment plans, especially if the surgery was for cancer.
Common temporary side effects can include changes in bowel habits, such as more frequent or looser stools. Patients are instructed on signs of potential complications, such as fever, increasing pain, or persistent nausea and vomiting, and when to contact their medical team for further evaluation.