Right hemicolectomy involves removing part of the colon, cecum, terminal ileum, and lymph nodes. It is the standard treatment for right colon cancers. The procedure removes the cecum, ascending colon, first part of the transverse colon, and lymph nodes. Indications include adenocarcinoma of the right colon, adenomatous polyps that cannot be removed endoscopically, inflammatory bowel disease, and diverticulitis. Risks include anastomotic leak, hemorrhage, bowel obstruction, and injury to nearby organs. Pre-op preparation includes bowel cleansing and antibiotics.

1. Right Hemicolectomy
Presenter- Dr Lalthlamuana
DNB Student General Surgery
Date:4/10/2023

2. Introduction
• Right hemicolectomy is a procedure that involves removing the
cecum, the ascending colon, the hepatic flexure,the first third of
the transverse colon, and part of the terminal ileum, along with
fat and lymph nodes.
• It is the standard surgical treatment for malignant neoplasms of
the right colon

3. Anatomy
• The colon is a 5- to 6-ft-long
• Embryologically, it develops partly from the midgut (ascending colon
to proximal transverse colon) and partly from the hindgut (distal
transverse colon to sigmoid colon).
• The ascending (right) colon lies vertically in the most lateral right
part of the abdominal cavity.
• The cecum is at the proximal blind end (pouch) of the ascending
colon. The ascending colon takes a right-angle turn just below the
liver (right colic or hepatic flexure) and becomes the transverse
colon, which has a horizontal course from right to left.

4. Blood Supply
• The colon is supplied by the superior mesenteric artery through
its right colic and middle colic branches and
• By the inferior mesenteric artery through its left colic and
multiple sigmoid branches.
• The terminal branches of these arteries entering the colonic wall
are called vasa recta.

5. INDICATIONS
• Indications for open right hemicolectomy include numerous benign
and malignant conditions.
• The most common malignant condition is adenocarcinoma of the
right colon; other malignant indications are malignant tumors of the
appendix and cecum.

6. INDICATIONS
• The benign conditions include adenomatous polyps of the colon that
cannot be removed endoscopically,
• carcinoids,
• inflammatory bowel disease (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).

7. INDICATIONS
• Open right hemicolectomy is also performed as a conversion
from initial laparoscopic right hemicolectomy;
• As many as 20% of laparoscopic colectomies for cancer may
require conversion to the equivalent open procedures.

8. Contraindications
• The main contraindication for right hemicolectomy in patients
with malignancies is acute obstruction, for which a two-stage
right hemicolectomy is advisable.
• 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.

9. Contraindications
• Therefore, in the first stage, an ileotransverse anastomosis is
performed, and in the second, a right hemicolectomy is
performed.
• Other contraindications include significant cardiopulmonary
impairment and coagulopathy.

10. ANESTHESIA
• GA
• POSITION
Supine
• Diagnosis
Confirmed by colonoscopic biopsy
Staging by CECT

11. Informed consent- risks of surgery
 Anastomotic leak- 2%
 Hemorrhage- 1%
 Bowel obstruction- 2%
 Wound infection- 2 to 10%
 Injury to ureter and duodenum- 1%

12. Pre-op preparation
Adequate mechanical bowel preparation the day before surgery with
orthograde enema
 Prophylactic IV broad spectrum antibiotics
 VTE prophylaxis with LMWH and pneumatic stockings

13. OPEN RIGHT HEMICOLECTOMY

31. THANK YOU