Overview of Hemicolectomy

A hemicolectomy is a common type of surgery that is done to treat colon cancer. The first successful surgery of this kind took place in 1832 by a surgeon named Reybard. Over the years, the surgery has been improved by other experienced surgeons, including Kohler and Mikulicz.

In today’s world, this surgery is usually performed laparoscopically when it’s possible. This means that instead of making one large incision, the surgeon makes a few small cuts and inserts a camera to see inside the body. They then use small tools to perform the surgery. This method is less invasive and often results in a faster recovery time.

Additionally, robotic techniques are being developed to refine the process even further. This is a revolutionary way of doing surgeries for colon cancer, and it’s an exciting future prospect in the world of medicine.

This article will give you more information about the structure of the colon, why this surgery might be needed, the equipment used, the people involved in the operation, how the procedure is performed, and the team approach to the surgery.

Anatomy and Physiology of Hemicolectomy

Understanding the anatomy for a hemicolectomy, a type of surgery that removes part of the colon, requires knowledge of certain structures including the colon, blood supply, lymphatic supply, and peritoneal attachments. Here’s some information on these parts and how they relate to right and left hemicolectomy.

The colon is made up of the cecum (the first part of the large intestine), appendix, ascending colon (the part that goes upwards), hepatic flexure (the curve near the liver), transverse colon (runs across the body), splenic flexure (the curve near the spleen), descending colon (the part that goes downwards), and the sigmoid colon (the last part). The ileocaecal valve is the door between the small intestine and the cecum. Some parts of the colon originate from the midgut, like the cecum to two-thirds of the transverse colon, and others from the hindgut, like the remaining one third of the transverse colon to the sigmoid colon.

The right part of the colon starts in a small pouch, the cecum, located in the lower right part of the abdomen. The ascending colon is covered by a layer of thin tissue called peritoneum. The hepatic flexure is close to the liver. There’s also a space next to the colon which serves as a collection point for fluids in the abdomen. The blood supply to this part comes from the superior mesenteric artery, located near the bottom of the backbone.

Moving onto the left side, the transverse colon is attached to the stomach and to a part of the body called the greater omentum. The splenic flexure is quite stationary, but care is needed to prevent tearing during surgery. The descending colon, on the other hand, is behind the peritoneum. The sigmoid colon is surrounded by the peritoneum and links to the side of the abdomen. The blood supply here comes from the inferior mesenteric artery. This part is drained by the inferior mesenteric vein.

The superior hypogastric plexus, a collection of nerves, is near the inferior mesenteric artery and has to be preserved during surgery, as it plays a vital role in controlling the intestine’s movement and blood flow.

Why do People Need Hemicolectomy

A hemicolectomy is a surgery that doctors use most often to treat colon cancer. Besides colon cancer, there are other reasons why a doctor might recommend this surgery. These include inflammatory bowel disease, which is a condition that causes inflammation in the digestive tract. Other reasons include a blockage or tear in a colon cancer, a colonic polyp that has a high chance of becoming cancerous, or a cecal volvulus, which is a twist in the lowest part of the intestines. Also, if someone has diverticular disease, a condition where small pouches form in the colon, isolated to just the right or left side, they might need this surgery.

Sometimes, if appendicitis is very severe and affects a part of the large intestine called the cecum, a hemicolectomy might be necessary. Additionally, ischemic colitis, a condition that causes inflammation and injury to the colon due to reduced blood flow, may necessitate a hemicolectomy. Non-medical accidents or medical mistakes (like a perforation, which is a small hole, that happens during a colonoscopy) can also lead to the need for a hemicolectomy.

When a Person Should Avoid Hemicolectomy

There are certain situations where the risks of surgery may outweigh the benefits, particularly for people with specific health conditions, like heart or kidney disease, or if they are elderly. How well a person was able to function before getting sick is also considered. The use of a guide called the P-Possum score can help predict the possibility of complications or even death after surgery. This score should be used to weigh the pros and cons of undergoing surgery versus not having it at all.

Equipment used for Hemicolectomy

Here is a rundown of the most common tools used during laparoscopic surgery, or a surgery done by making small incisions and using a camera to guide the process:

* A scalpel which is a small surgical knife, Langenbach retractors that are used to hold back tissues, and clips to stop blood flow
* A 30° laparoscope, which is a thin tube with a camera and light at the end, and a monitor to display the view from the camera
* Equipment to fill the abdomen with gas, this makes it easier for the surgeon to see and operate
* Hasson trocars which are devices used to make a hole through which the laparoscope and other tools can be inserted, these come in different sizes (5 mm and 10-12 mm)
* Three tools designed to safely hold your intestines
* A laparoscopic ultrasonic dissector or a special surgical tool that uses ultrasonic vibrations to cut and coagulate tissues
* Equipment for electrocautery, a process that uses electricity to heat tissues
* A laparoscopic suction irrigator, a tool for cleaning the area where the surgery is being done
* Clips that are specially designed for laparoscopic surgery
* A medium-sized device to protect the wound
* A laparoscopic linear cutting stapler, a tool that cuts tissue and applies staples in a single step
* A standard gastrointestinal anastomosis stapler, it’s a special kind of stapler used in operations on the digestive system
* A non-cutting stapler which is used when you want to join tissues with staples without cutting
* When doing a left hemicolectomy (removal of part of your left colon), a circular cutting stapler is used
* Foley catheter, a flexible tube that’s often inserted into the bladder to drain urine.

Who is needed to perform Hemicolectomy?

In a surgery room, the team performing the operation includes a main surgeon, a helping surgeon, a nurse who prepares the tools (scrub nurse), and people who assist in the surgery (theatre assistants). There is also a team that helps you sleep during the surgery (anesthetic team). This includes an anesthetist, who is a specialist that controls your sleep medicine, and an assistant who helps them.

The preparation for this operation involves various healthcare professionals. These include nurses who specialize in cancer care, nurses who help with care when a bypass is created for waste to leave your body (stoma care nurses), experts who take and interpret medical images (radiology), specialists who examine body tissues (histopathology), and your care team on the hospital floor (ward teams). This team is made up of doctors, nurses, pharmacists, health care assistants who provide general care, and staff who handle paperwork and other administrative tasks. They all work together to ensure your care goes smoothly before, during, and after your operation.

Preparing for Hemicolectomy

Before a patient has a surgery to remove part of the colon, called a hemicolectomy, a series of tests are performed. These tests are designed to make sure the patient is healthy enough for surgery. They examine the patient’s blood count, blood type, kidney function, and heart health. In some cases, additional tests may evaluate the patient’s lung and heart health in more detail, if needed.

As part of preparation before the surgery, if there is no blockage in the bowel, patients typically undergo a bowel prep to clear out the intestines. This helps limit complications that could occur after the colon is reconnected during the surgery. This is usually achieved by using a combination of medicines such as sodium picosulphate and magnesium citrate, which help to cleanse the bowel.

To help reduce the risk of infection during and after the surgery, antibiotics are given. Cefuroxime and metronidazole are typically used just before anesthesia is administered. They help fight off bacteria that naturally live in the gut and could lead to an infection. In cases where the surgery is complicated by heavy presence of bowel contents, the antibiotics may be used for a longer period.

Once the patient is anesthetized, a catheter is inserted into the bladder. This is performed to monitor the fluid output of the patient after the operation, making sure the body is maintaining the proper fluid balance. This helps doctors understand how well the patient recovers after the surgery.

How is Hemicolectomy performed

Doctors perform surgery to treat colon cancer and to avoid the spread of the disease by removing the lymph nodes connected to the blood vessels that supply the area being treated. The technique used depends on the location of the cancer. For example, in a right hemicolectomy, the doctors remove parts of the large intestine and its accompanying arteries. Similarly, for a left hemicolectomy, a part of the large intestine on the left side together with the blood vessels is removed. For cancers located near the spleen, a more extensive procedure called extended right hemicolectomy is often used. There isn’t a standard method for this type of cancer, as experts continue to research the best approach.

Let me walk you through what a right hemicolectomy looks like:

First, the patient is positioned in a way to give the surgeon the best access to the intestine. The surgeon then makes small incisions in the abdomen and inserts a camera and small tools to assist with the surgery. Using these tools, the surgeon carefully separates the right half of the colon from the surrounding tissue and cuts off its blood supply by clipping and dividing the arteries. Then, the surgeon connects the remaining parts of the intestine before ensuring everything is in place and there are no leaks. The surgeon then closes up the incisions made at the beginning of the procedure. This surgery can be performed, not just with the use of a camera, but also through larger incisions or with the assistance of a robot.

The procedure for the left hemicolectomy is quite similar:

During this operation, the surgeon begins by separating the left part of the colon from the surrounding tissue before cutting off its blood supply. After this, the remaining parts of the colon are joined together. Lastly, the surgeon ensures that everything is in place and there are no leaks, before closing up the incisions.

These operations are carried out under general anesthesia and aim to remove the part of the colon affected by cancer along with nearby lymph nodes to avoid the spread of cancerous cells. Recovery times can vary but might be shorter if smaller incisions are used with the assistance of a camera. The method chosen will depend on various factors including the location and stage of cancer, as well as the patient’s overall health.

Possible Complications of Hemicolectomy

Laparoscopic surgery for colorectal conditions has similar overall complication rates to traditional, open surgeries. Evidence from research studies suggests that laparoscopic surgery can lead to quicker recovery times and it doesn’t affect survival rates compared to open surgery. Several issues specific to laparoscopic hemicolectomy will be discussed here. These include leaks in the joins of the intestines, damage to the tubes that carry urine from the kidneys to the bladder (ureters), and needing to switch to open surgery.

Leaks in the joins of the intestines, known as anastomotic leaks, occur in about 4% of these laparoscopic operations and represent a major risk for further health problems. Certain factors can increase the risk of leaks. General factors can include a poor nutritional state, having too little iron in the body (anemia), a build-up of waste products in the blood due to kidney failure (uremia), diabetes, steroid usage, age, smoking, and infection. Local reasons can include poor blood supply, improper tension, or infection at the site of joining the intestines. Symptoms of a leak can occur anytime in the first 2 to 3 weeks after the operation. Signs to look out for include fever, a fast heart rate, a lack of bowel activity (ileus), lack of oxygen in the blood (hypoxemia), and failure to recover as expected after surgery. If the leak worsens, it can lead to a severe infection of the abdomen from fecal matter entering the abdomen (peritonitis).

Ureteric injuries can be difficult to identify in patients who are obese or have diseases such as diverticular disease and inflammatory bowel disease, or previous abdominal surgeries. Pre-surgery placement of ureteral stents (tubes to keep the ureters open) can help doctors detect any injuries to the ureters. However, ureteral injuries are rare.

Sometimes, conversion to open surgery is needed. This could be due to extensive scar tissue from previous surgeries, advanced tumors, or uncontrollable bleeding. Choosing to convert to open surgery can lead to worse survival rates.

Laparoscopic surgery has the advantage of reducing blood loss during the operation and lowering the risk of infection at the surgical wound compared to open surgery.

What Else Should I Know About Hemicolectomy?

Improving the understanding of the process involved in a hemicolectomy, a surgery where part of the colon is removed, is crucial for trainees to provide better assistance during the procedure. It’s very important for them to anticipate what is coming next during the surgery; this can help them prepare the necessary equipment, coordinate with the surgical team, move aside body tissue, and operate the laparoscopic camera, a device used to inspect and operate inside the body.

Moreover, knowing about the potential complications that can occur during a hemicolectomy and how to recognize them early can help manage these problems promptly. This leads to better health results for the patient.

Frequently asked questions

1. What are the potential risks and complications associated with a hemicolectomy? 2. How long is the typical recovery time after a hemicolectomy? 3. Will I need any additional treatments or therapies after the surgery? 4. What can I expect in terms of pain management during and after the surgery? 5. Are there any dietary or lifestyle changes I should make before or after the surgery?

Hemicolectomy is a surgery that removes part of the colon, and it can have various effects on the body. The specific effects will depend on which part of the colon is removed. Some potential effects include changes in bowel movements, the need for a temporary or permanent colostomy bag, and potential complications such as infection or bleeding. It is important to discuss the potential effects and risks with a healthcare professional before undergoing the surgery.

The reason someone may need a Hemicolectomy is not mentioned in the provided text.

You should not get a Hemicolectomy if you have specific health conditions such as heart or kidney disease, or if you are elderly. The P-Possum score can help predict the possibility of complications or death after surgery, and should be used to weigh the pros and cons of undergoing surgery.

The recovery time for Hemicolectomy can vary, but it may be shorter if smaller incisions are used with the assistance of a camera. The method chosen for the surgery will depend on factors such as the location and stage of cancer, as well as the patient's overall health. Laparoscopic surgery for colorectal conditions has been shown to have quicker recovery times compared to open surgery.

To prepare for a hemicolectomy, a series of tests will be performed to ensure you are healthy enough for surgery. These tests will evaluate your blood count, blood type, kidney function, and heart health. In addition, you may undergo a bowel prep to clear out your intestines and antibiotics will be given to reduce the risk of infection.

The complications of Hemicolectomy include leaks in the joins of the intestines (anastomotic leaks), damage to the ureters (tubes that carry urine from the kidneys to the bladder), and the need to switch to open surgery. Anastomotic leaks occur in about 4% of laparoscopic hemicolectomy operations and can lead to further health problems. Factors that increase the risk of leaks include poor nutritional state, anemia, kidney failure, diabetes, steroid usage, age, smoking, and infection. Symptoms of a leak can occur within the first 2 to 3 weeks after the operation and include fever, fast heart rate, lack of bowel activity, lack of oxygen in the blood, and failure to recover as expected. Ureteric injuries are rare but can be difficult to identify in obese patients or those with certain diseases or previous abdominal surgeries. Conversion to open surgery may be necessary due to scar tissue, advanced tumors, or uncontrollable bleeding, but this can lead to worse survival rates. Laparoscopic surgery reduces blood loss and lowers the risk of infection compared to open surgery.

The text does not provide specific symptoms that would require a Hemicolectomy. However, some conditions that may require this surgery include colon cancer, inflammatory bowel disease, blockage or tear in the colon, colonic polyps with a high chance of becoming cancerous, cecal volvulus, diverticular disease, severe appendicitis affecting the cecum, ischemic colitis, and non-medical accidents or medical mistakes.

There is no information provided in the given text about the safety of hemicolectomy specifically in pregnancy. It is recommended to consult with a healthcare professional for personalized advice and information regarding the safety and risks of any surgical procedure during pregnancy.

Join our newsletter

Stay up to date with the latest news and promotions!

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

We care about your data in our privacy policy.