Right hemicolectomy

Right hemicolectomy

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  Right hemicolectomy Warujpong Boonkum BudhachinarajHospital ,Phitsanolok
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  NINTH EDITION ZOLLINGER’SATLAS OF SURGICAL OPERATIONS Robert M. Zollinger, Jr., MD, FACS
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  INDICATIONS  Carcinoma ofright colon cancer and right proximal of transverse colon  Inflammatory bowel disease  More rarely for tuberculosis  Volvulus  the cecum  ascending colon  hepatic flexure
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  PREOPERATIVE PREPARATION • Correctionof fluid and electrolyte imbalances. • The proximal bowel is decompressed with a nasogastric tube. • Right colectomy can be performed in an unprepared bowel • Blood transfusion may be advisable, especially in older patients with cardiovascular disease • Perioperative systemic antibiotics are given.
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  ANESTHESIA • Either generalinhalation or spinal anesthesia is satisfactory.
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  POSITION • The patientis placed in a comfortable supine position. • The surgeon stands on the patient’s right side.
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  OPERATIVE PREPARATION • Theskin is prepared in the routine manner and a sterile drape applied.
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  INCISION AND EXPOSURE •A liberal midline incision centered about the umbilicus is made.
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  DETAILS OF PROCEDURE -Midline incision was made and abdomen was entered. - Generalized exploration was performed. - Adhesionolysis was performed. - Terminal ileum was mobilized. - Ileocolic vessels were double ligated with 2-0 silk and divided close to their origin. - Mesentery of terminal ileum was divided.
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  - Two Kocherclamps were applied and terminal ileum was divided. - Peritoneal attachment of cecum and ascending colon was incised to free the ascending colon. - Right colic vessels were ligated and divided closed to their origin. - Hepatic flexure was mobilized by dividing its peritoneal attachment.
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  • Right ureterwas identified and preserved. • Second part duodenum was identified and retracted. • Transverse colon was mobilized by divided greater omentum and mesotransverse colon. • Middle colic vessels were double ligated with 2-0 silk and divided close to their origin. • Transverse colon were transected with GIA-60mm, blue cartridge. • The spacimen was removed.
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  • End-to-side anastomosiswas performed with two layer fashion, interupted full thickness 3-0 Vicryl and 3-0 silk seromuscular sutures. • Mesenteric defect was closed with 3-0 silk. • Abdomen was irrigated with warm NSS. • Abdomen was closed with interupted#1 Vicryl. • Skin was irrigated with normal saline solution. Skin was closed with skin staplers. • Patient was extubated and transferred to recovery room in stable condition.
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  THE END