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Right hemicolectomy Warujpong Boonkum Budhachinaraj Hospital ,Phitsanolok
NINTH EDITION ZOLLINGER’S ATLAS OF SURGICAL OPERATIONS Robert M. Zollinger, Jr., MD, FACS
INDICATIONS  Carcinoma of right colon cancer and right proximal of transverse colon  Inflammatory bowel disease  More r...
PREOPERATIVE PREPARATION • Correction of fluid and electrolyte imbalances. • The proximal bowel is decompressed with a nas...
ANESTHESIA • Either general inhalation or spinal anesthesia is satisfactory.
POSITION • The patient is placed in a comfortable supine position. • The surgeon stands on the patient’s right side.
OPERATIVE PREPARATION • The skin is prepared in the routine manner and a sterile drape applied.
INCISION AND EXPOSURE • A liberal midline incision centered about the umbilicus is made.
DETAILS OF PROCEDURE - Midline incision was made and abdomen was entered. - Generalized exploration was performed. - Adhes...
- Two Kocher clamps were applied and terminal ileum was divided. - Peritoneal attachment of cecum and ascending colon was ...
• Right ureter was identified and preserved. • Second part duodenum was identified and retracted. • Transverse colon was m...
• End-to-side anastomosis was performed with two layer fashion, interupted full thickness 3-0 Vicryl and 3-0 silk seromusc...
THE END
Right hemicolectomy
Right hemicolectomy
Right hemicolectomy
Right hemicolectomy
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Right hemicolectomy

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Pre operative for Rt.hemicolectomy

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Right hemicolectomy

  1. 1. Right hemicolectomy Warujpong Boonkum Budhachinaraj Hospital ,Phitsanolok
  2. 2. NINTH EDITION ZOLLINGER’S ATLAS OF SURGICAL OPERATIONS Robert M. Zollinger, Jr., MD, FACS
  3. 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. 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. 5. ANESTHESIA • Either general inhalation or spinal anesthesia is satisfactory.
  6. 6. POSITION • The patient is placed in a comfortable supine position. • The surgeon stands on the patient’s right side.
  7. 7. OPERATIVE PREPARATION • The skin is prepared in the routine manner and a sterile drape applied.
  8. 8. INCISION AND EXPOSURE • A liberal midline incision centered about the umbilicus is made.
  9. 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. 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. 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. 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.
  13. 13. THE END

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