A right hemicolectomy is a surgical intervention where the right half of the colon is removed, most often the cecum, ascending colon, and part of the transverse colon. It is often done to treat conditions like colon cancer, crohn’s disease, diverticular disease, or large polyps that cannot be removed via an endoscope.
The procedure may be conducted either through an open procedure or minimally invasive methods (laparoscopic or robotic assisted). In the procedure, the diseased part of the colon is removed, and the remaining healthy colon is reconnected to allow for normal digestive process.
Right hemicolectomy is an established and effective surgical treatment, with possible advantages including disease resolution, relief of symptoms, and enhanced quality of life.
However, as with any surgery, it carries risks, including infection, bleeding, and complications related to bowel function. Postoperative care focuses on pain management, dietary adjustments, and monitoring for complications to promote optimal recovery.
Indications
Colorectal Cancer & Precancerous Conditions
Right-sided colon cancer, including cecal and ascending colon adenocarcinoma.
Hereditary colorectal conditions such as Lynch syndrome and familial adenomatous polyposis.
Large or high-risk polyps that cannot be removed endoscopically.
Inflammatory Bowel Disease (IBD)
Crohn’s disease with strictures, fistulas, or severe inflammation in the right colon
Ulcerative colitis with dysplasia requiring segmental resection instead of total colectomy
Diverticular Disease
Right-sided diverticulitis, though less common, may require surgery if complicated by perforation, abscess, or bleeding.
Bowel Obstruction & Ischemia
Malignant obstruction from a right colon tumor.
Benign strictures due to prior inflammation, ischemia, or chronic diverticulitis.
Non-reversible or necrotic colonic ischemia.
Trauma & Perforation
Blunt or penetrating abdominal trauma involving the right colon.
Spontaneous or procedure-related perforation, such as from a colonoscopy.
Contraindications
Unresectable Metastatic Disease: When cancer cells have advanced across colon boundaries and make surgical intervention ineffective for survivability purposes.
Severe Uncontrolled Comorbidities: Surgery poses too high a risk for patients who have extreme and unregulated medical conditions including severe heart failure and unstable coronary artery disease and respiratory failure.
Severe Coagulopathy: A severe bleeding disorder that makes patients prone to major surgical bleeding constitutes a condition that prevents undergoing surgery.
Inability to Tolerate General Anesthesia: The patient cannot receive general anesthesia because of severe medical illnesses including advanced lung disease and other life-threatening conditions.
Extensive Peritoneal Carcinomatosis: Widespread cancer spread in the peritoneal cavity makes advanced surgical intervention impossible to achieve cure.
Active Severe Infection or Sepsis: Severe infections, especially within the abdomen, that need to be treated before surgery can be considered.
Poor Nutritional Status: Severe malnutrition may increase surgical risks and require preoperative nutritional optimization.
Severe Adhesions or Prior Extensive Abdominal Surgeries: The patient requires treatment for active severe infections and sepsis because these severe abdominal conditions prevent the surgeon from performing surgery.
History and Physical Examination: Assess medical history, comorbidities, and previous abdominal surgeries.
Laboratory Tests:
Complete blood count (CBC)
Electrolytes, renal and liver function tests
Coagulation profile
Blood typing and crossmatching (if needed)
Nutritional Assessment:
Correct any malnutrition or anemia (iron supplements if necessary) Bowel Preparation
Mechanical bowel preparation (e.g., polyethylene glycol solution) is sometimes used, but its necessity is debated.
Oral antibiotics (e.g., neomycin and metronidazole) may be given the day before surgery to reduce infection risk.
In some cases, only dietary restrictions (clear liquids 24 hours before surgery) are required.
Preoperative Medications
Prophylactic Antibiotics: Administered within 60 minutes before incision to prevent surgical site infections. Thromboprophylaxis:
Low molecular weight heparin (LMWH) for high-risk patients
Compression stockings or pneumatic devices for DVT prevention
Pain Management:
Discuss postoperative analgesia (e.g., epidural, patient-controlled analgesia) Bowel Function Optimization:
Avoid excessive laxative use to prevent dehydration and electrolyte imbalance
Patient Education & Consent
Explain the procedure, risks (infection, bleeding, anastomotic leak, ileus), and expected recovery.
Discuss potential need for a stoma (if complications arise).
Patient position
Supine Position: The patient lies in a supine position on the operating table.
Arm Position: Arms can be tucked at the sides or positioned on arm boards, as preferred by the surgeon or as a consideration for anesthesia.
Right hemicolectomy
Step 1: Preoperative Preparation Patient evaluation: Comprises imaging studies (e.g., CT scan) and laboratory examinations. Bowel preparation: May incorporate dietary restriction and laxatives. Anesthesia: General anesthesia is given. Step 2: Incision and Exposure Incision: A midline incision is created, depending on the preference of the surgeon. Exploration: Exploration of the abdominal cavity to determine the status of the colon and surrounding tissues.
Step 3: Mobilization of the Cecum and Right Colon
Cecum mobilization: The cecum (the pouch connecting the small intestine to the colon) is freed by incising the peritoneum along the cecocolic ligament.
Right colon mobilization: The right colon (ascending colon and sometimes part of the transverse colon) is mobilized by carefully cutting through the peritoneum along the right paracolic gutter. This allows the colon to be moved toward the midline.
Step 4: Colon Division Ligation of vessels: The ileocolic artery, right colic artery, and other major blood vessels supplying the right colon are carefully ligated to minimize blood loss.
Resection: The surgeon performs right colon resection by removing the cecum and ascending colon and transverse colon portion according to disease location specifications.
Step 5: Anastomosis (Reconnection) Ileocolic anastomosis: The ileum from the small intestine is joined to the transverse colon through anastomosis by using sutures or staples.
End-to-end anastomosis: Direct end-to-end suturing of ileum and colon creates this procedure.
Step 6: Inspection and Closure
Thoroughly examine the anastomosis location to verify both leakage and bleeding from this site. Evaluate for the correct closure of all blood vessels.
The surgical team uses saline solution to wash the abdominal cavity through the process of peritoneal lavage.
Perform a multilayer closure of the abdominal wall by stitching or stapling.
Step 7: Postoperative Care Regular patient observation must take place to check for indications of infection alongside bleeding and bowel leakage.
Administer appropriate pain relief.
Active patient mobility should start soon after surgery to prevent deep vein thrombosis (DVT) as well as pneumonia development.
Complications
Infection: Includes wound infections, intra-abdominal abscesses, or anastomotic infections.
Anastomotic Leak: A severe complication where the newly connected bowel leaks, leading to peritonitis or sepsis.
Bleeding (Hemorrhage): Can be intra-abdominal or from the anastomosis site, sometimes requiring reoperation.
Bowel Obstruction: Due to post-surgical adhesions, ileus (temporary paralysis of the bowel), or anastomotic stricture.
Deep Vein Thrombosis (DVT) & Pulmonary Embolism (PE): Due to prolonged immobility and hypercoagulable state after surgery.
Ileus (Delayed Return of Bowel Function): Common in abdominal surgeries, leading to nausea, vomiting, and bloating.
Incisional Hernia: A weakness in the abdominal wall at the site of the incision, leading to a bulging hernia.
Chronic Diarrhea or Changed Bowel Habits: Surgery on the colon causes bowel movements alterations and may cause chronic diarrhea.
Nutritional Deficiencies: A major resection of the small intestine causes malabsorption and creates nutritional deficiencies that affect vitamin B12 alongside other essential nutrients.
A right hemicolectomy is a surgical intervention where the right half of the colon is removed, most often the cecum, ascending colon, and part of the transverse colon. It is often done to treat conditions like colon cancer, crohn’s disease, diverticular disease, or large polyps that cannot be removed via an endoscope.
The procedure may be conducted either through an open procedure or minimally invasive methods (laparoscopic or robotic assisted). In the procedure, the diseased part of the colon is removed, and the remaining healthy colon is reconnected to allow for normal digestive process.
Right hemicolectomy is an established and effective surgical treatment, with possible advantages including disease resolution, relief of symptoms, and enhanced quality of life.
However, as with any surgery, it carries risks, including infection, bleeding, and complications related to bowel function. Postoperative care focuses on pain management, dietary adjustments, and monitoring for complications to promote optimal recovery.
Colorectal Cancer & Precancerous Conditions
Right-sided colon cancer, including cecal and ascending colon adenocarcinoma.
Hereditary colorectal conditions such as Lynch syndrome and familial adenomatous polyposis.
Large or high-risk polyps that cannot be removed endoscopically.
Inflammatory Bowel Disease (IBD)
Crohn’s disease with strictures, fistulas, or severe inflammation in the right colon
Ulcerative colitis with dysplasia requiring segmental resection instead of total colectomy
Diverticular Disease
Right-sided diverticulitis, though less common, may require surgery if complicated by perforation, abscess, or bleeding.
Bowel Obstruction & Ischemia
Malignant obstruction from a right colon tumor.
Benign strictures due to prior inflammation, ischemia, or chronic diverticulitis.
Non-reversible or necrotic colonic ischemia.
Trauma & Perforation
Blunt or penetrating abdominal trauma involving the right colon.
Spontaneous or procedure-related perforation, such as from a colonoscopy.
Unresectable Metastatic Disease: When cancer cells have advanced across colon boundaries and make surgical intervention ineffective for survivability purposes.
Severe Uncontrolled Comorbidities: Surgery poses too high a risk for patients who have extreme and unregulated medical conditions including severe heart failure and unstable coronary artery disease and respiratory failure.
Severe Coagulopathy: A severe bleeding disorder that makes patients prone to major surgical bleeding constitutes a condition that prevents undergoing surgery.
Inability to Tolerate General Anesthesia: The patient cannot receive general anesthesia because of severe medical illnesses including advanced lung disease and other life-threatening conditions.
Extensive Peritoneal Carcinomatosis: Widespread cancer spread in the peritoneal cavity makes advanced surgical intervention impossible to achieve cure.
Active Severe Infection or Sepsis: Severe infections, especially within the abdomen, that need to be treated before surgery can be considered.
Poor Nutritional Status: Severe malnutrition may increase surgical risks and require preoperative nutritional optimization.
Severe Adhesions or Prior Extensive Abdominal Surgeries: The patient requires treatment for active severe infections and sepsis because these severe abdominal conditions prevent the surgeon from performing surgery.
History and Physical Examination: Assess medical history, comorbidities, and previous abdominal surgeries.
Laboratory Tests:
Complete blood count (CBC)
Electrolytes, renal and liver function tests
Coagulation profile
Blood typing and crossmatching (if needed)
Nutritional Assessment:
Correct any malnutrition or anemia (iron supplements if necessary) Bowel Preparation
Mechanical bowel preparation (e.g., polyethylene glycol solution) is sometimes used, but its necessity is debated.
Oral antibiotics (e.g., neomycin and metronidazole) may be given the day before surgery to reduce infection risk.
In some cases, only dietary restrictions (clear liquids 24 hours before surgery) are required.
Preoperative Medications
Prophylactic Antibiotics: Administered within 60 minutes before incision to prevent surgical site infections. Thromboprophylaxis:
Low molecular weight heparin (LMWH) for high-risk patients
Compression stockings or pneumatic devices for DVT prevention
Pain Management:
Discuss postoperative analgesia (e.g., epidural, patient-controlled analgesia) Bowel Function Optimization:
Avoid excessive laxative use to prevent dehydration and electrolyte imbalance
Patient Education & Consent
Explain the procedure, risks (infection, bleeding, anastomotic leak, ileus), and expected recovery.
Discuss potential need for a stoma (if complications arise).
Patient position
Supine Position: The patient lies in a supine position on the operating table.
Arm Position: Arms can be tucked at the sides or positioned on arm boards, as preferred by the surgeon or as a consideration for anesthesia.
Right hemicolectomy
Step 1: Preoperative Preparation Patient evaluation: Comprises imaging studies (e.g., CT scan) and laboratory examinations. Bowel preparation: May incorporate dietary restriction and laxatives. Anesthesia: General anesthesia is given. Step 2: Incision and Exposure Incision: A midline incision is created, depending on the preference of the surgeon. Exploration: Exploration of the abdominal cavity to determine the status of the colon and surrounding tissues.
Step 3: Mobilization of the Cecum and Right Colon
Cecum mobilization: The cecum (the pouch connecting the small intestine to the colon) is freed by incising the peritoneum along the cecocolic ligament.
Right colon mobilization: The right colon (ascending colon and sometimes part of the transverse colon) is mobilized by carefully cutting through the peritoneum along the right paracolic gutter. This allows the colon to be moved toward the midline.
Step 4: Colon Division Ligation of vessels: The ileocolic artery, right colic artery, and other major blood vessels supplying the right colon are carefully ligated to minimize blood loss.
Resection: The surgeon performs right colon resection by removing the cecum and ascending colon and transverse colon portion according to disease location specifications.
Step 5: Anastomosis (Reconnection) Ileocolic anastomosis: The ileum from the small intestine is joined to the transverse colon through anastomosis by using sutures or staples.
End-to-end anastomosis: Direct end-to-end suturing of ileum and colon creates this procedure.
Step 6: Inspection and Closure
Thoroughly examine the anastomosis location to verify both leakage and bleeding from this site. Evaluate for the correct closure of all blood vessels.
The surgical team uses saline solution to wash the abdominal cavity through the process of peritoneal lavage.
Perform a multilayer closure of the abdominal wall by stitching or stapling.
Step 7: Postoperative Care Regular patient observation must take place to check for indications of infection alongside bleeding and bowel leakage.
Administer appropriate pain relief.
Active patient mobility should start soon after surgery to prevent deep vein thrombosis (DVT) as well as pneumonia development.
Complications
Infection: Includes wound infections, intra-abdominal abscesses, or anastomotic infections.
Anastomotic Leak: A severe complication where the newly connected bowel leaks, leading to peritonitis or sepsis.
Bleeding (Hemorrhage): Can be intra-abdominal or from the anastomosis site, sometimes requiring reoperation.
Bowel Obstruction: Due to post-surgical adhesions, ileus (temporary paralysis of the bowel), or anastomotic stricture.
Deep Vein Thrombosis (DVT) & Pulmonary Embolism (PE): Due to prolonged immobility and hypercoagulable state after surgery.
Ileus (Delayed Return of Bowel Function): Common in abdominal surgeries, leading to nausea, vomiting, and bloating.
Incisional Hernia: A weakness in the abdominal wall at the site of the incision, leading to a bulging hernia.
Chronic Diarrhea or Changed Bowel Habits: Surgery on the colon causes bowel movements alterations and may cause chronic diarrhea.
Nutritional Deficiencies: A major resection of the small intestine causes malabsorption and creates nutritional deficiencies that affect vitamin B12 alongside other essential nutrients.
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