Hemicolectomy indications, complications

1. Right hemicolectomy

2. Right hemicolectomy
 It involves the removal of ---
 1. Terminal 15-25cm of ileum
 2. The cecum
 3. Appendix
 4. Ascending colon
 5. Proximal 1/3rd of transverse colon

3. Indications
 1.Inflammatory / infective
 A. Hyperplastic ileocaecal tuberculosis.
 B. Severe amoebic colitis with gangrene of caecum and
ascending colon.
 C. Inflammatory bowel disease limited to cecum and
ascending colon.
 D. Actinomycosis of ileocecal region.
 E. Acute gangrenous appendicitis with extension to
cecum.

4. 2. Vascular
 A. Ileocolic intussusception with gangrene.
 B. Cecal valvulus associated with gangrene of cecum.
 C. Gangrene of right side colon.

5. 3. Neoplasia
 A. Adenocarcinoma of colon.
 B. Adenocarcinoma of appendix
 C. GIST of terminal ileum.
 D. Carcinoid of appendix.

6. Preoperative bowel preparation
1. low residue diet is started 5-7 days before surgery.
2. oral laxative like bisacodyl tablets 2 days before
surgery.
3. bowel wash a day before surgery by polyethylene
glycol (peglec) solution.
4. Antibiotic bowel preparation includes luminal
antibiotics and systemic antibiotics.

7. CONTINUED….
5. Luminal include 1. neomycin 1gm and erythromycin
base 1gm.it is given day before operation at 1pm
,3pm and 11 pm when surgery is posted 9am on next
day.
6. Systemic antibiotic include third generation
cephalsporines and metronidazole.
7. Mechanical bowel preparation include .1.total gut
irrigation 2.osmotic catharsis 3.on table lavage.
8. Urinary bladder is catheterised before operation

8.  ANAESTHESIA –
 THE PROCEDURE IS PERFORMED UNDER
GENERAL ANAESTHESIAWITH PATIENT LYING IN
SUPINE POSITION.

 INCISION –Abdomen is opened by midline incision.

9. procedure
 For good intraperitoneal access Small bowel is
explored and packed in left upper quadrant to exclude
it from operative field.
 The peritoneum is incised along the white line lateral
to right colon which is relatively avascular. The
incision is extended to hepatic flexture along the right
paracolic gutter.
 The areolar plane is identified by retraction of
ascending colon forword and medially .

10.  The colon is mobilised lateral to medial side by
combination of blunt and sharp dissection and
allowing the gonadal vessel and ureter to fall back into
place.
 To mobilise the hepatic flexture the greater omentum
is divided over proximal 1/3rd of transverse colon.
 Hepatic flexture is then mobilised after dividing the
peritoneum reflexion between colon and duodenum.

11.  As dissection is continued medially , the second part
of duodenum and anterior surface of pancreas is
exposed. The care must be taken to prevent the tear to
small vessel in this area. If bleeding does occur it is
best treated initially by the application of an
adrenaline soaked swab for 5minute. If bleeding
continue then it should be controlled by a fine suture.
 Then the line of transection of mesentry is lateral to
the main trunk of the superior mesenteric
vessels.which must be preserved.

12.  The ileocolic and right colic artery and right branch
of middle colic artery are identified and ligated close
to the their origin .
 The bowel is resected as defined and assessed for
viability of ends.
 The ileocecal valve , 15-25 cm of ileum ,the ileocolic
vascular arcade with associated lymphatic
drainage,ascending colon and right 1/3rd of transverse
colon are included in the sample.

13.  Ileocolic anastomosis may be then constructed end to
end or side to side either with hand sutures or with
stapling device.

14.  COMPLICATIONS
 Early complication
 Haemorrhage
 Anastomotic dehiscence
 Duodenal injury
 Ureteric injury
 Wound infections