Open Right Hemicolectomy

The case

The colon, or large bowel, absorbs water and forms stool. Its right side starts at the cecum in the lower right belly, where the small bowel empties into it, and runs up the ascending colon to the bend under the liver and partway across the transverse colon. A right hemicolectomy removes this right side together with the last part of the small bowel (the terminal ileum) and the fatty tissue (mesentery) that carries their blood vessels and lymph nodes. The small bowel is then joined to the remaining transverse colon so stool can pass as before.

The most common reason is colon cancer of the cecum or ascending colon, or a polyp too large or too risky to remove through a colonoscope. Other reasons include Crohn's disease, bleeding, a twisted cecum (volvulus), appendicitis that has spread to the cecum, loss of blood supply, and injury. For cancer, the surgeon removes the blood vessels and lymph nodes with the bowel so they can be checked. The operation is often done laparoscopically or with a robot. The open operation is done through a cut down the middle of the belly; the choice is the surgeon's, and a blockage, a large tumor or many old adhesions can make the laparoscopic way harder.

Before surgery people usually take a bowel prep and antibiotic pills the day before. The operation is done under general anesthesia, sometimes with an epidural for pain afterward. Recovery plans encourage walking the same day, and people go home once they are eating and passing gas. Most normal activities return in 6 to 8 weeks, and bowel habits may change a little. Possible problems include a leak where the bowel is joined, infection, bleeding, blood clots, injury to the ureter, and a later blockage from scar tissue.