Pre operative for Rt.hemicolectomy

1. Right hemicolectomy
Warujpong Boonkum
Budhachinaraj Hospital ,Phitsanolok

2. NINTH EDITION ZOLLINGER’S ATLAS OF SURGICAL OPERATIONS Robert M. Zollinger, Jr., MD, FACS

3. INDICATIONS
 Carcinoma of right colon cancer and right proximal of transverse
colon
 Inflammatory bowel disease
 More rarely for tuberculosis
 Volvulus
 the cecum
 ascending colon
 hepatic flexure

4. PREOPERATIVE PREPARATION
• Correction of fluid and electrolyte imbalances.
• The proximal bowel is decompressed with a
nasogastric tube.
• Right colectomy can be performed in an
unprepared bowel
• Blood transfusion may be advisable, especially in
older patients with cardiovascular disease
• Perioperative systemic antibiotics are given.

5. ANESTHESIA
• Either general inhalation or spinal anesthesia is satisfactory.

6. POSITION
• The patient is placed in a comfortable supine
position.
• The surgeon stands on the patient’s right side.

7. OPERATIVE PREPARATION
• The skin is prepared in the routine manner and a sterile drape
applied.

8. INCISION AND EXPOSURE
• A liberal midline incision centered about the
umbilicus is made.

9. DETAILS OF PROCEDURE
- Midline incision was made and abdomen was entered.
- Generalized exploration was performed.
- Adhesionolysis was performed.
- Terminal ileum was mobilized.
- Ileocolic vessels were double ligated with 2-0 silk and
divided close to their origin.
- Mesentery of terminal ileum was divided.

10. - Two Kocher clamps were applied and terminal ileum was
divided.
- Peritoneal attachment of cecum and ascending colon was
incised to free the ascending colon.
- Right colic vessels were ligated and divided closed to their
origin.
- Hepatic flexure was mobilized by dividing its peritoneal
attachment.

11. • Right ureter was identified and preserved.
• Second part duodenum was identified and retracted.
• Transverse colon was mobilized by divided greater
omentum and mesotransverse colon.
• Middle colic vessels were double ligated with 2-0 silk
and divided close to their origin.
• Transverse colon were transected with GIA-60mm, blue
cartridge.
• The spacimen was removed.

12. • End-to-side anastomosis was performed with two layer fashion,
interupted full thickness 3-0 Vicryl and 3-0 silk seromuscular
sutures.
• Mesenteric defect was closed with 3-0 silk.
• Abdomen was irrigated with warm NSS.
• Abdomen was closed with interupted#1 Vicryl.
• Skin was irrigated with normal saline solution. Skin was closed
with skin staplers.
• Patient was extubated and transferred to recovery room in stable
condition.

17. THE END