Right Colectomy

Edward H. Phillips, MD
Student Author:
Matthew Zeller, DO

Background Information: A colectomy is the surgical removal of the colon or large bowel. Similar to most procedures these days, a colectomy may be performed open or with minimally invasive techniques. Variations of this procedure are performed based on the location of the pathology location. Often, bowel resections include a much larger portion of the bowel than what is directly impacted by the tumor due to the need to remove regional lymph nodes alongside vessels supplying the tumor. Removing the lymph nodes allows proper staging and treatment for malignant indications. 


Indications: 

General indications for colectomy can include, but are not limited to:

  • Infectious: diverticulitis, fulminant Clostridium difficile infection
  • Inflammatory: inflammatory bowel diseases
  • Malignant: colorectal cancer, appendiceal cancers, carcinoid tumor
  • Other: trauma, ischemia, volvulus

Indications for partial colectomies are based on the pathology and the location they occur. Right hemicolectomy is indicated in the setting of right-sided tumors specifically within the cecum or ascending colon. If the tumor extends into the transverse colon, the right hemicolectomy can be extended to include the majority of the transverse colon (i.e., extended right hemicolectomy).


Procedure Description: During a right hemicolectomy, the terminal ileum (TI), cecum, appendix, ascending colon, and splenic flexure are removed. For the laparoscopic method of right hemicolectomy, a medial to lateral approach of mobilization of the mesentery is common. First, vascular control and ligation is performed. Working lateral, the transverse colon is transected followed by the TI. Next, the ascending colon is mobilized from its attachment to the posterior abdominal wall. The specimen then placed out of th operative view and the ileotransverse anastomosis is created. Any mesenteric defects are closed prior to exiting the abdominal cavity. For, laparotomy, the colon is often mobilized prior to vascular control. 


Key Anatomy:

Bowel

  • Colon
  • Transverse
  • White line of Toldt
  • Ascending
  • Cecum
  • Teniae coli
  • Small Bowel
  • Terminal ileum

Greater omentum

Vasculature

  • Superior mesenteric artery (SMA)
  • Middle colic artery
  • Right colic artery
  • Ileocolic artery & pedicle


Risks:

General surgical risks:

  • Bleeding
  • Infection

Risks specific to colectomy

  • Anastomotic leak 1%1 - 8%2
  • Rare risks:
  • Necrosis of colon
  • Bowel twisting 


Text:

  • Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice by Courtney M. Townsend Jr. MD
  • Atlas of General Surgical Techniques: Townsend, Evers
  • The SAGES Manual of Colorectal Surgery, by Patricia Sylla, Andreas M. Kaiser, Daniel Popowich


Online resources:

  • Osmosis 

  1. Veyrie, N., Ata, T., Muscari, F., Couchard, A. C., Msika, S., Hay, J. M., … Dziri, C. (2007). Anastomotic Leakage after Elective Right Versus Left Colectomy for Cancer: Prevalence and Independent Risk Factors. Journal of the American College of Surgeons, 205(6), 785–793. https://doi.org/10.1016/j.jamcollsurg.2007.06.284
  2. Battersby, N., Bhangu, A., Chaudhri, S., El-Hussuna, A., Frasson, M., Nepogodiev, D., … Tan, S. (2017). Relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit. Colorectal Disease, 19(8), e296–e311. https://doi.org/10.1111/codi.13646