The document discusses various types of colectomy procedures, including ileocolic, right, transverse, left, sigmoid, total, subtotal colectomy, and proctocolectomy, outlining their indications and surgical techniques. Each colectomy type addresses specific lesions or diseases, detailing vessel ligation, resection areas, and anastomosis creation. It highlights the technical difficulties and considerations for ensuring adequate blood supply during surgeries.

1. Colectomy
By solomon (MD,R)

2. • variety of terms are used to describe different types of colectomy
• Ileocolic Resection
• describes a limited resection of the terminal ileum, cecum, and appendix
• It is used to remove disease involving these segments (e.g., ileocecal Crohn’s disease) and
benign lesions or incurable cancers arising in the terminal ileum, cecum, and, occasionally, the
appendix
• If curable malignancy --more radical resections, such as a right hemicolectomy
• The ileocolic vessels are ligated and divided
• A primary anastomosis is created between the distal small bowel and the ascending colon
• It is technically difficult to perform an anastomosis at or just proximal to the ileocecal valve;
therefore, if the most distal ileum needs to be resected, the cecum is generally also removed

3. • Right Colectomy
• used to remove lesions or disease in the right colon and is oncologically the most appropriate
operation for curative intent resection of proximal colon carcinoma
• The ileocolic vessels, right colic vessels, and right branches of the middle colic vessels are
ligated and divided
• Approximately 10 cm of terminal ileum are usually included in the resection
• A primary ileal-transverse colon anastomosis is almost always possible

4. • Extended Right Colectomy
• An extended right colectomy may be used for curative intent resection of lesions located at
the hepatic flexure or proximal transverse colon
• A standard right colectomy is extended to include ligation of the middle colic vessels at their
base
• The right colon and proximal transverse colon are resected, and a primary anastomosis is
created between the distal ileum and distal transverse colon
• Such an anastomosis relies on the marginal artery of Drummond
• If the blood supply to the distal transverse colon is questionable, the resection is extended
distally beyond the splenic flexure to well perfused descending colon where the ileocolic
anastomosis can be performed safely
•

5. • Transverse Colectomy
• Lesions in the mid and distal transverse colon may be resected by ligating the middle colic
vessels and resecting the transverse colon, followed by a colocolonic anastomosis
• However, an extended right colectomy with an anastomosis between the terminal ileum and
descending colon may be a safer anastomosis with an equivalent functional result

6. • Left Colectomy
• For lesions or disease states confined to the distal transverse colon, splenic flexure, or
descending colon, a left colectomy is performed
• The left branches of the middle colic vessels, the left colic vessels, and the first branches of
the sigmoid vessels are ligated
• A colocolonic anastomosis can usually be performed

7. • Extended Left Colectomy
• An extended left colectomy is an option for removing lesions in the distal transverse colon
• In this operation, the left colectomy is extended proximally to include the right branches of the
middle colic vessels
• Sigmoid Colectomy
• Lesions in the sigmoid colon require ligation and division of the sigmoid branches of the
inferior mesenteric artery
• In general, the entire sigmoid colon should be resected to the level of the peritoneal reflection
and an anastomosis created between the descending colon and upper rectum
• Full mobilization of the splenic flexure is often required to create a tension-free anastomosis

8. • Total and Subtotal Colectomy
• Total or subtotal colectomy is occasionally required for patients with fulminant colitis,
attenuated FAP, or synchronous colon carcinomas
• The ileocolic vessels, right colic vessels, middle colic vessels, and left colic vessels are ligated
and divided
• The superior rectal vessels are preserved
• If it is desired to preserve the sigmoid, the distal sigmoid vessels are left intact, and an
anastomosis is created between the ileum and distal sigmoid colon (subtotal colectomy with
ileosigmoid anastomosis)
• If the sigmoid is to be resected, the sigmoidal vessels are ligated and divided, and the ileum is
anastomosed to the upper rectum (total abdominal colectomy with ileorectal anastomosis)
• If an anastomosis is contraindicated, an end ileostomy is created, and the remaining sigmoid or
rectum is managed either as a mucus fistula or a Hartmann’s pouch

9. • Proctocolectomy
• Total Proctocolectomy
• In this procedure, the entire colon, rectum, and anus are removed, and the ileum is brought to
the skin as a Brooke ileostomy

10. • Schwartz 11th ed.