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.
General indications for colectomy can include, but are not limited to:
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.
General surgical risks:
Risks specific to colectomy