Hemicolectomy

About Hemicolectomy

Hemicolectomy removes approximately one half of the colon. A right hemicolectomy removes the cecum, ascending colon and part of the transverse colon together with the end of the small intestine, followed by a connection between the ileum and the transverse colon. It is performed for cancers of the right colon, tumors of the appendix, some cases of Crohn disease and cecal volvulus. A left hemicolectomy removes the descending colon and often part of the sigmoid colon, followed by a connection between the transverse colon and the remaining sigmoid colon or rectum, and is used for left sided cancers, diverticular disease and volvulus. In cancer surgery the blood vessels are divided close to their origin so that the lymph nodes along them are removed with the specimen. Complete mesocolic excision with central vascular ligation, described by the German surgeon Werner Hohenberger, removes the colon within its intact envelope of fatty tissue and aims to improve lymph node retrieval and cancer outcomes. Laparoscopic surgery is widely used and is often performed with a medial to lateral approach that identifies the vessels first, while robotic surgery is increasingly common. Enhanced recovery programs combining early eating, multimodal pain control and early mobilization allow relatively short hospital stays. The most important specific complication is leakage from the bowel connection; others include bleeding, infection, temporary paralysis of the bowel called ileus and injury to nearby structures such as the ureter or duodenum. The removed tissue is examined to stage the cancer and guide further treatment such as chemotherapy.