Right Colectomy

Background Information:

‍A colectomy is the surgical removal of the colon or large bowel. This procedure may be perfomed open or with minimally invasive techniques (laparoscopic or robotic). Variations of this procedure are performed based on the location of the pathology location. Often, bowel resections include a much larger portion of the bowel than what is directly impacted by the tumor due to the need to remove regional lymph nodes alongside vessels supplying the tumor. Removing lymph nodes allows proper staging and treatment for malignant indications. 

Indications: 

General indications for colectomy can include, but are not limited to:

• Infectious: diverticulitis, fulminant Clostridioides difficile colitis
• Inflammatory: inflammatory bowel diseases
• Malignant: colorectal cancer, appendiceal cancers, carcinoid tumor
• Other: trauma, ischemia, volvulus

Indications for partial colectomies are based on the pathology and the location they occur. Right hemicolectomy is indicated in the setting of right-sided tumors specifically within the cecum or ascending colon. If the tumor extends into the transverse colon, the right hemicolectomy can be extended to include the majority of the transverse colon (i.e., extended right hemicolectomy).

Procedure Description: During a right hemicolectomy, the terminal ileum (TI), cecum, appendix, ascending colon, and splenic flexure are removed. For the laparoscopic method of right hemicolectomy, a medial to lateral approach of mobilization of the mesentery is common. First, vascular control and ligation is performed. Working lateral, the transverse colon is transected followed by the TI. Next, the ascending colon is mobilized from its attachment to the posterior abdominal wall. The specimen then placed out of the operative view and the ileotransverse anastomosis is created. Any mesenteric defects are closed prior to exiting the abdominal cavity. For an open approach, the colon is often mobilized prior to vascular control. 

Key Anatomy:

Bowel

• Colon

• ~Transverse
• ~Ascending

• ~~White line of Toldt

• ~Cecum
• ~Teniae coli

• Small Bowel

• ~Terminal ileum

Greater omentum

Vasculature

• Superior mesenteric artery (SMA)
• Middle colic artery
• Right colic artery
• Ileocolic artery & pedicle

Risks:

General surgical risks:

• Bleeding
• Infection

Risks specific to colectomy

• Anastomotic leak 1%ⁱ - 8%²
• Rare risks:

• ~Necrosis of colon
• ~Bowel twisting 

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