Right Hemicolectomy (Right Colon Resection or Removal) Open Technique Indications Malignancy (most often the cancer is an adenocarcinoma)

Diverticulitis Ischemia Perforation Incision Longitudinal midline this is the most common incision and runs up and down usually from just above the symphysis pubis (pubic bone) to above the umbilicus (belly button). Transverse lower right quadrant this incision is used less commonly but gives good exposure at the ileocecal region (where the small bowel turns into the large bowel). Surgical Details of the Procedure 1. An incision is made in the skin with a #10 blade 2. Bovie cautery is used to dissect the subcutaneous fascia 3. The scalpel is used to incise the fascia in the midline (usually above the umbilicus) between the rectus muscles. 4. The peritoneum is grasped between two forceps and palpated to insure that bowel is not present 5. The peritoneum is incised with a Metzenbaum scissors. 6. If purulent or bloody peritoneal fluid is returned, a culturette swab is obtained times two. 7. The balance of the incision is opened. 8. Bookwalter, Balfour, or Thompson retractors are used to provide exposure 9. An incision is made at the peritoneal reflection lateral to the cecum. 10. Dissection upwards towards the hepatic flexure (area of the colon next to the liver) from this initial incision is performed, usually with the Bovie Cautery. 11. The hepatic flexure of the colon is taken down or released from its retroperitoneal attachments. 12. Care must be taken in ligating the small blood vessels in the hepatic-colic ligament (connective tissue between the colon and the liver). 13. Care must be taken to not injure the 2nd and 3rd part of the duodenum, which is directly deep to the hepatic flexure of the colon. 14. Once the retroperitoneal attachments are freed the right colon can be lifted toward the midline. 15. The right ureter may be visualized running under the elevated right colon. 16. The area of transection in the transverse colon is selected by palpating for the middle colic vessels and its right branches.

17. The omentum is freed off the area of resection of the colon by using hemostats or Kelly clamps to cross-clamp and then ligate with 2-0 silk ties 18. A hemostat or Kelly clamp is used to open a window in the mesentery just beneath the edge of the bowel on the mesenteric side at the planned area of transection. 19. A one half of a GIA bowel stapler is placed through the just formed mesenteric window and one half is placed over the bowel wall. 20. The GIA stapler is closed and fired transecting the bowel wall. 21. The transection area of the terminal ileum is selected and a hemostat or Kelly clamp is used to open a small window in the mesentery.

Right Hemicolectomy
The colon, or large bowel, has three sides: the ascending colon (right side), the transverse colon, and the

descending colon (left side).

Colectomy
The primary treatment for colon cancer is surgery. The part of the large bowel with cancer is removed, along with surrounding lymph nodes. Removal of the colon is called a colectomy. The remaining bowel is then joined together. Joining the bowel is called an anastomosis. When cancer is found in the ascending colon, the right side is removed. The colon is then joined to the small intestine

Right Hemicolectomy before surgery. The grey area shows the part of the bowel the surgeon will remove.

Right Hemicolectomy after surgery. The large bowel now is attached to the small bowel. At Cedars-Sinai, the majority of colon and rectal operations are performed using minimally invasive techniques (laparoscopy). The benefits of minimally invasive surgery include less pain after surgery, faster return of bowel function, quicker healing, less scarring and fewer days in the hospital to recover. Laparoscopy, however, may not be suitable for all patients. Ask your surgeon if you are an appropriate candidate for minimally invasive surgery.

Chemotherapy
After the surgeon removes the section of the colon, a pathologist evaluates the cancer under a microscope. If the pathologist sees evidence that cancer has spread to the lymph nodes, or if the cancer is a type that grows quickly, the oncologist will usually recommend further treatment with chemotherapy.

Follow-up Care
Bowel movements might be more frequent after a colectomy, but usually become more normal after one year. Your doctor can recommend a bowel care plan to help normalize bowel movements. The most common time a cancer recurs is within the first two years following diagnosis and treatment. Follow-up care with the surgeon, gastroenterologist and oncologist is important. Periodic checkups may include a physical exam, blood tests, colonoscopy, CT scan or PET scan.

Overview
Background
Open right hemicolectomy (open right colectomy) involves removing the cecum, the ascending colon, the hepatic flexure (where the ascending colon joins the transverse colon), the first one-third of the transverse colon, and part of the terminal ileum, along with fat and lymph nodes.[1] It is the standard surgical treatment of malignant neoplasms of the right colon and the one by which other techniques are measured. The first successful resection and anastomosis of the bowel for carcinoma was reported in 1832 by Reybord, who recorded his experiences with treatment of cancers of the colon. The second successful resection and anastomosis was performed by Kohler. Exteriorization-resection of carcinoma of colon was performed by Paul and Mikulicz. The following are the main types of right open hemicolectomy:

Right hemicolectomy in 1 stage, with end-to-end anastomosis by the open and closed techniques Modified Mikulicz operation for carcinoma of the right colon 2-stage right hemicolectomy - First stage, lateral or end-to-side ileocolostomy; second stage, right hemicolectomy Turnbull's method (no-touch isolation technique) Barnes' method (physiologic resection of the right colon)

Indications
Indications for open right hemicolectomy include numerous malignant and benign conditions. The most common malignant condition is adenocarcinoma of the right colon; other malignant indications are malignant tumors of the appendix and malignant tumors of the cecum. The benign conditions include adenomatous polyps of the colon that cannot be removed endoscopically, carcinoids, irritable bowel syndrome (Crohn disease and sometimes ulcerative colitis), cecal volvulus, severe appendicitis with involvement of the cecum in the inflammatory process, and isolated right-side colonic diverticular disease (rare).[3, 1]

Contraindications
The main contraindication for right hemicolectomy in patients with malignancies is a presentation with acute obstruction, in which a 2-stage right hemicolectomy is advisable. The authors believe that in cases of large intestinal obstruction with altered parameters and vital signs, a bypass procedure is

initially a better choice than radical resection, which the patient is less likely to tolerate. Therefore, in the first stage, an ileotransverse anastomosis is performed, and in the second, right hemicolectomy is performed. Other contraindications include significant cardiopulmonary impairment and coagulopathy.

Technical Considerations
Planning an operation for a patient with colon cancer requires the surgeon to have a thorough understanding of the tumor's location in the bowel, the stage of the cancer, and the patient's physiologic status. The location of the tumor and the histopathology are important data elements that allow preoperative selection of an operative plan and determination of the optimal resection margins. The presence of a lesion at watershed areas of vascular supply, such as the hepatic and splenic flexures, may necessitate more extensive resection of colonic length for a safe and complete oncologic procedure. An extended right or left colectomy may be indicated to remove all contributing vascular supplies. In addition, information consistent with hereditary nonpolyposis colon cancer supports the resection of the entire diseased colon rather than a simple segmental resection. This diagnosis may also be supported by special stains of the biopsy specimen that demonstrate microsatellite instability, the hallmark of the disease, which develops from mutations in the DNA mismatch repair system.[2]

Periprocedural Care
Preprocedural Planning
Before the operation, thorough preparation of the bowel is necessary. Standard bowel preparation may be conducted over a 24-hour period and is usually done after admission. The patient is allowed to drink only clear liquids for 24 hours. About 4 L of polyethylene glycol solution is given to the patient to be taken over 2-3 hours in the afternoon of the day before the procedure. A sodium phosphate enema is given on the night before the operation.[1] Two doses of metronidazole and neomycin sulfate are given after the lavage preparation on the day before surgery, and an intravenous (IV) second-generation cephalosporin is administered within 1 hour before incision. Electrolyte levels are obtained again on the night before surgery after the lavage.

Equipment
Open right hemicolectomy is performed with a standard laparotomy set, as follows:

Scalpel with No. 11 and No. 15 blades Curved and straight artery forceps A pair of toothed thumb forceps A pair of nontoothed forceps Allis forceps Noncrushing intestinal clamps Surgical cautery Hemostatic clips or ligatures

Handheld ultrasonic dissector (if available) Abdominal wall retractors/self-retaining retractors Atraumatic visceral retractors Suture material (absorbable and nonabsorbable) Anastomotic staplers

Patient Preparation
Patient preparation includes adequate anesthesia and proper positioning.

Anesthesia
General anesthesia is preferred for an open right hemicolectomy. An additional epidural block can be placed for postoperative pain management. After induction of anesthesia, a 16-French or 18-French Ryle tube is passed and kept on continuous drainage. The patient is then catheterized with a 14-French Foley catheter for monitoring of intraoperative and postoperative urine output.[2]

Positioning
The standard position for an open right hemicolectomy is supine with strapping of the ankle and wrists to allow intraoperative changes to other positions, such as the Trendelenburg position. The surgeon stands on the patient's left, and the first assistant stands across from the surgeon on the patient's right. The scrub nurse stands beside the surgeon. If a second assistant is needed, he or she usually stands across from the surgeon to the left of the first assistant.

Monitoring and Follow-up

Postoperatively, nasogastric aspiration is maintained until ileus resolves. Clear liquids are started when the patient has a soft abdomen with normal bowel sounds and expels flatus without nausea, vomiting, or abdominal distention. If the patient tolerates liquids well, normal intake can be started after 2 days. IV fluids should be continued until the patient can tolerate normal oral intake. The urinary catheter may be removed 2-3 days after the operation. Patients who recover sufficiently may be discharged on day 8, and sutures or staples may be removed on day 10.[1]

Technique
Approach Considerations
The following basic principles should be adhered to in colon resection:

The patient must be properly prepared before the operation Thorough bowel preparation must be performed preoperatively Incisions should be planned so as to yield optimal exposure Turnbull's no-touch technique should be used when possible The segment to be resected must be completely mobilized so that the surgeon can obtain good clearance as well as accomplish a tension-free anastomosis Adequate cancer clearance must be achieved both in the resected margins and in the lymphatic

fields An adequate blood supply to the segments involved in the anastomosis must be ensured An end-to-end anastomosis is preferred to a side-to-side or end-to-side anastomosis; the surgeon may use interrupted fine silk sutures in 1 or 2 layers or may use anastomotic staplers Good and secure abdominal closure must be achieved to facilitate early ambulation

Open Right Hemicolectomy

An open right hemicolectomy is performed as follows.

Choice of incision
The choice of incision varies according to the circumstances of the case (eg, the underlying pathology, the extent of the disease, and previous operations). A midline incision has the advantage of being easily extended to expose any area. This incision is preferred for patients with inflammatory bowel disease, because such patients may need frequent operations. A right paramedian incision (see the image below) provides good exposure and is suitable for planned right hemicolectomies.[1] Right paramedian incision.

Determination of extent of resection

The location of the tumor determines the line of resection. If the tumor is located in the cecum, a 10-cm margin of terminal ileum must be resected; however, if the tumor is located in the ascending colon, only a few centimeters of ileum is required as a margin. The line of resection should extend to the right side of the transverse colon at the level of the right branch of the middle colic vessels (see the images below). Extent of right hemicolectomy. adjacent to hepatic flexure removed with specimen. Part of distal ileum and part of transverse colon Right hemicolectomy specimen.

Care must be taken to preserve the main branch of the middle colic vessels. The right colic and ileocolic vessels are taken at their origins to ensure proper lymph node harvesting. Omental attachments to the right colon are generally removed with the specimen.

Mobilization of colon
The right colon is mobilized (see the image below) by separating the retroperitoneal structures from the terminal ileum and cecum. The most important of these are the ureter and the gonadal vessels. Separation is accomplished by incising the peritoneal attachments to these structures laterally and rotating the cecum anteriorly and medially. Incision along avascular line to mobilize right colon. Once this mobilization is completed, the attachments to the cecum and terminal small bowel are incised in an inferior-to-superior direction toward the junction of the third and fourth portions of the

duodenum. A sponge is often helpful in gently separating the filmy adhesions to the retroperitoneum posteriorly as mobilization continues superiorly. During this dissection, proper care should be taken to identify and posteriorly displace the gonadal vessels and ureter. Mobilization of the ileocolic vessels is complete once the middle colic artery is identified where it crosses the duodenum. The lateral dissection is continued upward and around the hepatic flexure with the surgeon's index finger; this provides the plane of dissection for cauterization by the first assistant. With the midtransverse colon retracted inferiorly, the exposure of the hepatic flexure is completed. The thin plane between the mesocolon and the gastrocolic ligament can be developed bluntly and dissected to complete the flexure mobilization (see the image below). During the mobilization of the gastrocolic ligament, a few vessels may have to be ligated. Entire right colon mobilized up to hepatic flexure. The proximal part of the transverse colon is mobilized by applying gentle traction to the transverse mesocolon. This maneuver must be performed with a gentle touch to avoid avulsing a branch of the middle colic vein from its origin. The right colon is then retracted superiorly and medially to exposing the anterior edge of the duodenum and the head of the pancreas (see the image below). Release of these filmy attachments is the last remaining step in the dissection. Duodenum and major vessels seen after full mobilization of right colon. The avascular area between the ileocolic artery and right branch of the middle colic artery is incised down to the base of the ileocolic vessels at about the level where it crosses the lateral or inferior edge of the duodenum. The peritoneum overlying the ileocolic vessels is incised, and the vessels are doubly ligated and divided. Next, the marginal branches to the ileum are divided, thus preparing the proximal line of resection. The right colic artery, if necessary, and the right branch of the middle colic artery are divided. The distal bowel margin is then cleared of fat and prepared for an anastomosis.[2]

Creation of anastomosis
The anastomosis may be created either with a stapler or by means of a hand-sewn technique. Stapled anastomosis A conventional stapled functional end-to-end anastomosis is accomplished with 1 or 2 firings of a linear cutting stapler and the use of a linear noncutting stapler. However, the current standard technique is a simplified procedure that uses only 2 firings of a disposable linear cutting stapler. Mesenteric fat around the colon and the terminal ileum is cleared away for approximately 1.5 cm. Transverse incisions about 1.5 cm long are made on the specimen side of these cleared areas on the antimesenteric borders of the ileum and colon. One of the 2 sides of the linear cutting stapler is placed into each of the holes, first in the small bowel and then in the colon. The stapler is gently closed, approximating the small bowel and the colon along the antimesenteric border. Once the stapler is in a good position, it is fired and removed. When the stapler is fired, the previously separate ileal and colonic enterotomies are joined into a single enterotomy, and a pair of Babcock clamps are used to grasp opposite borders of this enterotomy at the

anterior and posterior staple lines. A long (75-100 mm) linear cutting stapler is reloaded and placed across the ileum and transverse colon at a right angle to the previous staple line. With retraction of the previous enterotomy, the stapler is fired, completing the surgical resection and anastomosis. The mesenteric defect can be closed or left open, depending on the surgeon's preference. Omentum, if available, can be placed over the anastomosis to provide further protection against postoperative anastomotic leakage.[1] Hand-sewn anastomosis The handsewn anastomosis most often performed begins by placing crushing bowel clamps across the colon a few centimeters distal to the area to be divided on the ileum and a few centimeters proximal to the line of transection on the colon. Noncrushing clamps are then placed straight across the colon and ileum. At this point, the ileum and colon are divided, and the specimen is sent for pathologic evaluation. If the diameter of the transected ileum is small, it can be enlarged by dividing it longitudinally along its antimesenteric border. Three types of anastomosis can be created, as follows:

End-to-end Side-to-side End-to-side

First, the 2 ends of the bowel are approximated, with care taken to ensure that there are no twists; 3-0 stay sutures are placed in the corners of the bowel to aid in approximation. A posterior row of Lembert sutures is placed first. These sutures should be placed deep enough to incorporate most of the muscle layer. If the suture can be seen through the serosa, the stitch has been placed too superficially, and a deep needle passage is required. The sutures are tied so as to approximate tissues, not strangle them. Next, an inner layer of continuous 3-0 suture is used to approximate the mucosal and submucosal layers. The corner of the bowel is secured first, and the continuous suture is then advanced along the posterior aspect of the anastomosis. This suture is tied to itself at the corner. The occluding bowel clamps are removed from the bowel to allow blood flow to return to the ends of the bowel. The final step includes the anterior second layer of 3-0 Lembert sutures, which approximate the serosal layer and thus bolster the anastomotic line (see the images below).[2] Ileotransverse anastomosis. Ileum anchored to lateral abdominal wall.

Completion and closure

Before closure, the abdomen is checked for adequate hemostasis and thoroughly irrigated with saline. Drains are used only in cases of infection or abscess. Interrupted or continuous sutures are then used to close the fascial layer, and a continuous subcuticular suture or skin staples are used to approximate the skin.

Complications of Procedure
Complications of open right hemicolectomy include the following:

Postoperative ileus Anastomotic leakage Wound infection[1]

Patient Information: Hemicolectomy- Right

What is it? The bowel is a tube of intestine which runs from the stomach to the back passage. The lower part of the bowel is called the colon. The colon starts just to the right of the waistline and runs up under your ribs, across the tummy and down the left side where it becomes the rectum. Your problem is on the right hand side of the colon. The diseased part of the right colon and a small piece of the upper bowel have to be taken out. The ends of the rest of the bowel are joined up inside the tummy. The Operation You will have a general anaesthetic and will be asleep for the whole operation. A cut is made in the skin 25 cm (10") long. The right side of the colon and the lowest part of the small bowel are freed. The diseased bowel is taken out. The cut ends of the small bowel and of the middle of the colon are joined together. The cut is then closed up. You will not end up with a colostomy or need to wear a bag to collect the bowel waste. You should plan to leave hospital about 5-10 days after your operation. Any Alternatives? Simply waiting and seeing is not a good plan. The trouble you are having with the bowel will simply get worse and may well lead to very serious problems. Tablets and medicine will not be helpful, neither will x-ray or laser treatment. Key hole operation to remove this segment of bowel is now a safe proven alternative. Before the Operation Stop smoking and get your weight down if you are overweight. If you know that you have problems with your blood pressure, your heart or your lungs, ask your family doctor to check that these are under control. Check the hospitals advice about taking the pill or hormone replacement therapy (HRT). You may be required to take bowel preparation to clear the bowel prior to your

admission. Please follow the instructions carefully. If you come into hospital the day of your surgery, you must fast for 6 hours prior to your operation. Check that you have a relative or friend who can come with you to hospital, take you home and look after you for the first week after the operation. Bring all your tablets and medicines with you to hospital. On the ward you may be checked for past illnesses and may have special tests ready for the operation. You will be asked to fill in an operation consent form. Many hospitals now run special pre-admission clinics, where you visit for an hour or two, a week or so before the operation, for these checks. After - In Hospital You may have a fine plastic tube coming out of your nose and connected to another plastic bag to drain your stomach. Swallowing may be a little uncomfortable. You will have a dressing on your wound and perhaps a drainage tube nearby, connected to another plastic bag. The wound is painful and you will be given injections, and later tablets, to control this. Ask for more if the pain is still unpleasant. A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. Do not make important decisions during that time. You will probably have a fine drainage tube in the penis or front passage to drain the urine from the bladder until you are able to get out of bed easily. You should be eating and drinking normally after about 4 days. The wound has a dressing which may show some staining with old blood in the first 24 hours. There may be stitches or clips in the skin. Sometimes 7 or 8 stitches are put across the wound to add strength. Stitches and clips are removed after about 8 days. The drain tube is removed after 4 days or so. You can wash the area as soon as the dressing has been removed. Soap and tap water are entirely adequate. Salted water is not necessary. You can shower or bath as often as you want. You will be given an appointment to visit the Outpatient Department for a check up about one month after leaving hospital. The results from the laboratory about your colon will be ready by then. The nurses will advise about sick notes, certificates, etc. After - At Home You are likely to feel very tired and need rests 2-3 times a day for a month or more. You will gradually improve so that by the time 3 months has passed you will be able to return completely to your usual level of activity. You can drive as soon as you can make an emergency stop without discomfort in the wound, ie. after about 3 weeks. You can restart sexual relations within 2-3 weeks when the wound is comfortable enough. You should be able to return to a light job after about 6 weeks and any

heavy job within 12 weeks. Possible Complications Complications are unusual but are rapidly recognised by the nursing and surgical staff. If you think that all is not well, ask the nurses or doctors. You will be given injectable medication and stockings to avoid blood clots occurring in the leg. If pain or swelling occurs in either leg please alert nursing and medical staff immediately. Chest infections may arise, particularly in smokers. Co-operation with the physiotherapists to clear the air passages is important in preventing the condition. Do not smoke. Occasionally the bowel is slow to start working again. This may take a week or more. Your food and water intake will continue through your vein tubing. Sometimes there is some discharge from the drain near the wound. This stops given time. Sometimes the join in the bowel may leak. The doctor will talk to you about this. Wound infection is sometimes seen. This settles down with antibiotics in a week or two. Aches and twinges may be felt in the wound for up to 6 months. Occasionally there are numb patches in the skin around the wound which get better after 2-3 months. Because of loss of some of the bowel you may need vitamin replacement. This will be discussed with you. General Advice The operation should not be underestimated. Some patients are surprised how slowly they regain their normal stamina, but virtually all patients are back doing their normal duties within 3 months. We hope these notes will help you through your operation. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little. If you have any queries or problems, please ask the doctors or nurses.

Right Hemicolectomy
Preparation Patients undergoing a right hemicolectomy will undergo the standard preparation for a general anaesthetic. Investigations and specific preparation will be dependent upon the underlying disease process and will be discussed on an individual basis. Procedure This operation involves removing the right side of the large intestine with a small amount of the small

bowel. The exact extent of the resection is dependent upon the reason that the operation is being done and it is essential that the diseased portion of the bowel together with a healthy margin of normal tissue is removed. Apart from in very exceptional circumstances the cut end of the small bowel will be joined to the large bowel and there will be no requirement for a side passage. If possible this operation is performed using a laparoscopic assisted approach what this means is that three small incisions (approx 1cm) are made to insert a camera and instruments to aid dissection. After the bowel has been prepared and mobilised a small incision (about 5cm) is made to remove the diseased segment of the bowel and through this incision the ends of the bowel are joined together. Alternatively in some situations it is better to perform the operation through a conventional abdominal incision. Anaesthetic General Post Operative Recovery: In the immediate post operative period it is usual to monitor patients closely in a high dependency area. This allows a specialist nurse to measure certain parameters very closely and ensures that any untoward events are detected and treated early. Generally patients can expect to start drinking early and are then encouraged to take a light diet, as they manage this it is possible to remove intravenous drips and urinary catheters. Mobilisation is dependent upon adequate pain control and patients are encouraged to sit up and take a short walk (with assistance to start with) from an early stage. Patients can expect to stay in hospital for 4-7 days after their surgery but should expect to feel tired for several weeks after surgery. It is usual that patients experience some change in bowel habit following a right hemicolectomy in most cases this is a slight increase in frequency but rarely some patients may get diarrhoea after this operation. If this happens it is usually treated with a drug to slow down bowel function and often does improve with time. The bit of the small bowel that is removed is important for the absorbtion of vitamin B12 and it may be necessary to give supplements of this vitamin in some cases. A right hemicolectomy is usually a very straight forward operation however as with all surgery there is a risk of complications. These can be regarded as non-specific complications related to having an anaesthetic and being immobile in bed for some time and those specific to the operation. The nonspecific complications include:

Chest infections more common in smokers or patients with pre-existing lung diseases. Prophylactic physiotherapy will hopefully prevent this complication developing. Venous thrombosis and pulmonary embolism patients will be given drugs to thin the blood and try to prevent this and will receive physiotherapy and early mobilisation to minimise the risks. Cardiac complications -these are uncommon unless there is a specific risk factor in this situation appropriate measures will be taken to minimise the risks. a wound infection - a wound infection is usually manifest as pain, swelling and redness around the wound it may or may not discharge pus. In most cases a wound infection is treated with antibiotics. delayed return to normal gut function this is known as an ileus and may require longer than normal intravenous fluids. In the most prolonged cases treatment with intravenous nutrition may be required. leakage from the join between the small bowel and the large bowel this may necessitate

The specific complications of a right hemicolectomy are uncommon but include:

further surgery and possibly the formation of a side passage (or stoma) a hernia through the wound -this is obviously more common with open surgery and may require an additional operation to repair it.

The colon (also called the large intestine or bowel) as a long tube connected to the digestive tract. Colon surgeries can treat a variety of colon ailments, including cancer, chronic diseases, perforations or blockages. Some people facing a serious risk of future colon cancer may even opt for colon surgery as a preventative measure.

Types of Colon Surgeries

The bowel consists of three sections, with the right or ascending colon on the right side of the abdomen, the transverse colon extending across the center area, and the descending colon on the left. Depending on the location of the problem, a surgeon may perform different types of colectomy, or colon removal. A hemicolectomy involves removal of the left or right side of the colon.

Right Hemicolectomy

A right hemocolectomy involves removal of half of the bowel, then attaching the remaining section to the small intestine in a procedure known as an anastamosis. Many colon surgeries are performed using a technique called laparoscopy to help patients recover more quickly and with less scarring. The Comprehensive Center for Laparoscopic Surgery describes this minimally invasive procedure: Instead of making a large incision, the surgeon views his work on a video screen from cameras attached to miniscule telescopic tubes called canulas. The canulas enter the body through small incisions and the surgeon performs the entire procedure through these smaller incisions.

Complications

Possible complications from a right hemicolectomy include infection of the wound or chest area, bleeding, bowel damage and blood clots. The clots, which tend to form in the leg, can present a serious danger if they move to the lungs, a condition known as pulmonary embolism. Leakage at the site of the join may occur as well, but laparsocopy runs no greater complication rate than standard surgery.

Complication Patterns

The type of complication seems to depend on the underlying cause of the bowel problem. A study published in The American Journal of Gastroenterology found that patients with underlying irritable bowel syndrome had more abdominal complications, mainly due to infection, while patients with underlying cancer, who also tended to be older than the other group, experienced more system-wide complications.

Considerations

A surgeon may offer the option of a bypass procedure instead of a right hemicolectomy. According to the National Health Service, a bypass does not address the structural

problem in the bowel; instead, it simply reattaches one part of the bowel to a different section, allowing wastes to travel freely through the system. Patients should expect some recovery issues following a hemicolectomy. The bowel usually takes several days to resume performance, and at first the patient may experience slight bleeding. Bowel irregularity may require some modifications to the diet. Read more: Complications of Right Hemicolectomy Surgery | eHow.com http://www.ehow.com/about_5714138_complications-right-hemicolectomysurgery.html#ixzz1XlNcMRDb