Extended left hemicolectomy. Features of surgical treatment of colon cancer. Equipment and instruments required for the operation

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For colon cancer, the extent of resection, depending on the location of the tumor, ranges from distal resection of the sigmoid colon to colectomy, i.e. removal of the entire colon. The most commonly performed are distal resection of the sigmoid colon, segmental resection of the sigmoid colon, left-sided hemicolectomy, resection of the transverse colon, right-sided hemicolectomy (Fig. 1), subtotal resection of the colon. These operations differ from each other in the volume of resection of the colon, the anatomy of the transected vessels and, accordingly, the removed area of lymphogenous metastasis.

Rice. 1. Scheme of resection of the large intestine for cancer of various localizations: a - resection of the sigmoid colon; b - left-sided hemicolectomy; c - right hemicolectomy; d - resection of the transverse colon.

Distal resection of the sigmoid colon consists of resection of the distal two-thirds of the sigmoid colon and the upper third of the rectum with ligation of the sigmoid and upper rectal vessels. Restoration of the colon is carried out by forming a sigmorectal anastomosis.

Segmental resection of the sigmoid colon- resection of the middle part of the sigmoid colon with ligation of the sigmoid vessels and the formation of an anastomosis.

Left hemicolectomy involves removal of the left half of the colon (sigmoid, descending and distal half of the transverse colon) with ligation and intersection of the inferior mesenteric vessels and the formation of a transversorectal anastomosis.

Transverse colon resection involves ligation and intersection of the middle colon artery at its base and the formation of an anastomosis.

Right hemicolectomy consists of removing the cecum with the distal part of the ileum (10-15 cm), the ascending colon and the proximal third of the transverse colon with ligation and intersection of the ileocolic vessels, the right colon artery and the right branch of the middle colic artery. Restoration of intestinal continuity is carried out by forming an ileotransverse anastomosis.

Subtotal colon resection- removal of the entire colon, with the exception of the most distal part of the sigmoid colon, forming an ileosigmoid anastomosis. In this case, all the main vessels supplying the colon are crossed.

If lymph nodes are affected, extended resection volumes should be performed. Thus, for cancer of the sigmoid colon of any location in these cases, left-sided hemicolectomy with ligation of the inferior mesenteric arteries and veins and the formation of a transversorectal anastomosis is indicated. For cancer of the descending section or left flexure, distal subtotal resection of the colon with ligation of the trunk of not only the inferior mesenteric vessels, but also the middle colon artery with further formation of an ascendorectal anastomosis is indicated.

In the same situation, but with a right-sided localization of the tumor, proximal subtotal resection of the colon with ligation of the ileocolic, right colic and middle colic arteries and the formation of an ileosigmoid anastomosis is indicated. When the tumor is localized in the middle third of the transverse colon and the presence of lymphatic metastases, the extent of resection should range from subtotal resection to colectomy with ileorectal anastomosis. If the tumor is located in the right or left flexure of the colon, a typical right or left hemicolectomy is performed, respectively. If the lymph nodes are affected, proximal or distal subtotal resection of the colon is indicated, respectively.

When a colon tumor grows into neighboring organs (bladder, small intestine, stomach, etc.), combined operations should be used. Modern surgical techniques, features of anesthesia and intensive care allow simultaneous resection of any abdominal organ and retroperitoneal space. The use of intraoperative ultrasound helps to better differentiate true tumor growth from perifocal inflammation of nearby organs.

In recent years, along with intestinal resection, removal of distant metastases has been increasingly used, in particular liver resections of varying volume and technique (the so-called complete cytoreduction). Palliative resections (incomplete cytoreduction) should also be used in the absence of contraindications, trying whenever possible to avoid symptomatic surgery (formation of colostomies or bypass anastomoses).

Colon resections should be completed with the formation of an anastomosis with restoration of natural intestinal passage. This is possible if the following conditions are met: good bowel preparation, good blood supply to the anastomosed sections, absence of bowel tension in the area of the intended anastomosis.

When forming an anastomosis, the most widely used double-row interrupted suture with an atraumatic needle. It is also possible to use other options: mechanical staple suture, mechanical suture made of absorbable material or metal with shape memory, single-row manual suture, etc. If there is no confidence in the reliability of the colonic anastomosis, a proximal colostomy should be formed.

In case of tumor complications during urgent operations on an unprepared intestine, preference should be given to multi-stage treatment. At the first stage, it is advisable not only to eliminate the complications that have arisen, but also to remove the tumor itself; at the second stage, it is advisable to restore natural intestinal passage. Such methods of surgical treatment include the von Mikulich-Radetzky operation with the formation of a double-barreled colostomy and the Hartmann operation - the formation of a single-barrel colostomy and tightly suturing the distal segment of the colon. Restoration of natural intestinal passage is carried out after 2-6 months after the patient’s condition has normalized.

Savelyev V.S.

Surgical diseases

Indications and general principles are the same as for right-sided hemicolectomy, but with left-sided localization of the process. Access is left-sided para- (trans-) rectal or, better, lower-middle, bypassing the navel on the left and 5-6 cm above. During an examination of the abdominal organs, the operability of the tumor is determined and the extent of resection is outlined.

Mobilization of the intestine begins from the lateral recess in the direction from the targeted level of the sigma to the splenic flexure, which is mobilized by crossing the left diaphragmatic-colic ligament with ligation of the vessels passing through it. Next, the left third (or half, depending on the intended level of resection) of the gastrocolic ligament and greater omentum is ligated and dissected, and the intestine with the parietal peritoneum and retroperitoneal tissue is bluntly separated from the posterior abdominal wall upward and medially. The right half of the colon and small intestine are fenced off with gauze, and the resected colon with part of the greater omentum is removed into the wound. Having folded the omentum upward, the mesentery is exposed and the medial side of the intestine is mobilized, ligating and crossing the feeding vessels as centrally as possible; the colon is crossed between two clamps, having previously been delimited with gauze napkins; the specimen containing the tumor is removed.

The remaining ends of the sigmoid and transverse colon are brought together, the lumens are dried with tuffers, the mucous membrane is treated with antiseptics and a transverse sigmoidal anastomosis is applied end to end with a double-row suture, as described above.

If there is uncertainty about the tightness of the anastomosis, rubber drainage can be brought to it through an additional counter-aperture; in doubtful cases, especially in weakened patients, it is advisable to apply a temporary unloading cecostomy (transverso-)stomy.

If left-sided hemicolectomy is performed extended, with resection of the rectosigmoid (superior ampullary) region, mobilization of the distal area begins with a lyre-shaped incision involving the pelvic peritoneum. The inferior mesenteric artery is ligated with two ligatures and crossed at the wall of the abdominal aorta. Having completed mobilization, the rectum is crossed between the clamps and the specimen with the tumor is removed. Moreover, even after mobilization of the hepatic flexure, it is not always possible to bring the anastomosed ends of the intestines together without tension. In such cases, it is advisable to suture the upper two-thirds of the defect in the posterior layer of the parietal peritoneum and pass the maximally mobilized right half of the transverse colon through a window made in the avascular portion of the ileal mesentery. Often this makes it possible to bring together the crossed ends of the colon and rectum without tension and apply a transversorectal anastomosis. The same method is convenient to use for short mesentery of the colon. It is advisable to place such an anastomosis retroperitoneally, covering it with parietal peritoneum stitched over the anastomosis (lower third of the defect). Drainage of the retroperitoneal space through the counter-aperture. The gaps in the mesentery of the ileum are sutured. The abdominal cavity is drained and the abdominal wall wound is sutured in layers; microirrigators. Considering the technical complexity of the operation, it is advisable to apply a temporary decompression cecostoma (it is also necessary during surgery in severely ill patients).

Sometimes even this technique turns out to be insufficient to create a successful direct transversorectal anastomosis (loose type of structure of the vessels of the mesentery of the colon, narrow pelvis in men, etc.). In such cases, you have to choose: whether to complete the Hartmann operation - peritonization of the distal stump with immersion in the abdominal (pelvic) cavity and removal of the proximal end in the form of a single-barreled anus (preferably for malignant tumors) or go for more risky operations (single- and multi-stage plastic surgery) , which is justified only for hemicolectomy undertaken for a benign process.

In seriously ill patients, as well as in the presence of complications, it is advisable to perform the operation using a two-stage method (Grekov II), subsequently undertaking extraperitoneal, as with a two-stage right-sided hemicolectomy (or intraperitoneal), the imposition of a transverse sigmoidal anastomosis or tumor site.

Principle of right hemicolectomy- oncological resection of the right half of the colon with ligation of the vascular pedicle and corresponding lymphadenectomy.

A) Location. Hospital, operating room.

b) Alternative:
Laparoscopic access.
Extended right hemicolectomy (including both flexures and part of the descending colon).
Hartmann's operation with a long stump and end ileostomy.

V) Indications for right hemicolectomy: cancer of the right colon, diverticular disease, cecal volvulus.

G) Preparation:
A complete examination of the colon in all planned cases, marking (tattooing) of small tumors is desirable.
Mechanical bowel preparation (traditional) or no bowel preparation (an evolving concept).
Installation of ureteral stents in cases of repeated operations or pronounced anatomical changes (for example, inflammation).
Marking the stoma site.
Antibiotic prophylaxis.

d) Stages of right hemicolectomy surgery:

1. Patient position: supine, modified position for perineal stone dissection (surgeon's preference).
2. Laparotomy: mid-median, right transverse (from the navel), subcostal incision on the right.
3. Installation of an abdominal retractor and hand mirrors for exposure of the right colon.
4. Revision of the abdominal cavity: local resectability, secondary pathological changes (liver/gallbladder, small/large intestine, female genital organs), other changes.

5. Determination of resection boundaries:
A. Cecum/ascending colon: right branch of the middle colic artery.
b. Hepatic flexure: extended right hemicolectomy.

6. Mobilization of the right half of the colon: starts from the ileocecal junction and continues along the lateral canal to the hepatic flexure. Anatomical landmarks: ureter, duodenum (avoid injury!).
7. Dissection of the omental bursa: oncological principles of resection require at least hemiomentectomy on the tumor side; The division of the gastrocolic ligament is carried out in several stages (in case of a benign disease, the omentum can be preserved by separating it from the transverse colon).
8. Identification of the ileocolic vascular bundle: contoured by traction on the cecum towards the right lower quadrant.
9. Oncological ligation (ligation with suturing) of the vessels of the right half of the colon. Before cutting tissue, it is necessary to ensure the safety of the ureter.
10. Step-by-step ligation in the direction of the right branch of the middle colic artery.

11. Crossing the intestine and forming a side-to-side ileotransverse anastomosis with a stapler.
12. Removal and macroscopic examination of the specimen: verification of pathological changes and resection boundaries.
13. Strengthening the fastening seam with separate interrupted seams.

14. Suturing the window in the mesentery.
15. Drainage is not indicated (except in special cases). There is no need for (NGZ).
16. Suturing the wound.

e) Anatomical structures at risk of injury: right ureter, duodenum, superior mesenteric vein, middle colon artery.

and) Postoperative period: “fast-track” management of patients: taking fluids on the first postoperative day (in the absence of nausea and vomiting) and quickly expanding the diet as tolerated.

h) Complications of right hemicolectomy:
Bleeding (associated with surgery): traction on the superior mesenteric vein, inadequate ligation of the vascular pedicle, middle colic artery.
Anastomotic failure (2%): technical errors, tension, inadequate blood supply.
Damage to the ureter (0.1-0.2%).

Left hemicolectomy– a surgical intervention in which resection of the left half of the large intestine is performed with the formation of an anastomosis or a colostomy. Indications for left hemicolectomy include colon cancer, benign and precancerous polyps, Crohn's disease, ulcerative colitis, colonic bleeding, colonic perforation, and sigmoid volvulus. Hemicolectomy is performed laparoscopically (minimally invasive) or open. The operation is performed under general anesthesia; epidural analgesia is possible to improve pain relief during surgery and in the postoperative period. Potential complications include deep vein thrombosis, bleeding, infection, intestinal obstruction, and anastomotic leak.

Left hemicolectomy– a surgical intervention in which resection of the left half of the large intestine is performed with the formation of an anastomosis or a colostomy. Indications for surgery include colon cancer, benign and precancerous polyps, Crohn's disease, ulcerative colitis, colonic bleeding, colonic perforation and sigmoid volvulus. Hemicolectomy is performed laparoscopically (minimally invasive) or open. The operation is performed under general anesthesia; epidural analgesia is possible to improve pain relief during surgery and in the postoperative period. Potential complications include deep vein thrombosis, bleeding, infection, intestinal obstruction, and anastomotic leak.

Hemicolectomy is a surgical procedure used in the treatment of various diseases of the large intestine. Used in abdominal surgery, oncology and proctology. The history of colon resections begins in 1832, when Dr. Raybord reported the first successful operation with an interintestinal anastomosis. The first laparoscopic hemicolectomy was performed in the United States in 1990 by Dr. Jacobs.

Depending on the part of the colon to be removed, a distinction is made between left-sided and right-sided hemicolectomy. Both operations are performed open or laparoscopically. In an open hemicolectomy, half of the intestine is removed through a large incision in the abdominal wall. When using the laparoscopic technique, colon resection is performed through small holes under the control of a video camera using endoscopic equipment. The advantage of the open method is the absence of the need for expensive laparoscopic equipment, better visual viewing conditions, the ability to obtain tactile information about the condition of the abdominal organs, and lower prices. The advantages of laparoscopic hemicolectomy include reduced recovery time, less intense pain, absence of large scars, reduced risk of infectious complications and postoperative hernias, and early restoration of intestinal function.

Indications

Left-sided hemicolectomy is performed for cancer of the descending colon, sigmoid or rectum, polyposis and diverticulosis of the left half of the colon, ischemic and ulcerative colitis, perforation of the colon, bleeding from the left half of the colon and volvulus of the sigmoid colon.

Contraindications

There are no absolute contraindications to urgent hemicolectomy for health reasons. An example of such a situation would be intestinal perforation with peritonitis. In oncological diseases, hemicolectomy is contraindicated in patients with acute intestinal obstruction and the presence of distant metastases. In such cases, surgeons form a bypass interintestinal anastomosis or perform a stoma, since radical surgery does not improve the patient’s condition, but exposes him to a high risk of complications and causes an unjustified delay in systemic chemotherapy. Surgeons must carefully weigh the possible benefits and potential risks of hemicolectomy in each patient.

Elective resection of the left side of the colon is not performed in patients with severe concomitant diseases of the cardiovascular system and bleeding disorders. Performing hemicolectomy routinely in the presence of acute infection, severe renal or liver failure, decompensation of diabetes mellitus or other systemic diseases is possible only after stabilization of the patient's condition.

Contraindications to laparoscopic hemicolectomy include cancer spreading to adjacent organs, large tumor sizes, perforation and intestinal obstruction with severe distension of the colon, the presence of adhesions or scars in the abdominal cavity from previous operations, inability to pump carbon dioxide due to decompensation of cardiovascular or pulmonary diseases , shock, increased intracranial pressure, severe obesity.

Preparing for surgery

Before the operation, endoscopy of the large intestine (colonoscopy or sigmoidoscopy) is performed, during which, if indicated, a tissue biopsy is performed from the source of the disease to confirm the diagnosis. If it is impossible to use endoscopic techniques, irrigoscopy is performed - X-ray contrast examination of the intestine with barium administered through an enema. For malignant neoplasms, the examination plan is supplemented with computed tomography and other diagnostic methods to clarify the extent of tumor spread. A general clinical examination before hemicolectomy includes a general blood test, a general urinalysis, determination of blood group, biochemical blood test, fluorography, Wasserman reaction, ECG, consultation with a cardiologist, and, if necessary, other specialists.

Before a planned hemicolectomy, preoperative preparation is carried out, including correction of water and electrolyte metabolism and nutritional deficiencies. If necessary, treatment of concomitant diseases is prescribed in order to achieve a state of remission or compensation. In addition, before hemicolectomy it is necessary to prevent infectious complications with antibiotics. Intestinal cleansing begins in advance. To do this, the day before surgery, the patient is allowed to drink only clear liquids (water, broth, soup), laxatives are prescribed, and enemas are given. In some cases, the enema is repeated in the morning directly on the day of surgery. Before the intervention, the patient needs to take a hygienic shower.

Methodology

Open and laparoscopic hemicolectomy are performed under general anesthesia. Sometimes, for postoperative pain relief and to reduce the dose of administered narcotic substances, epidural anesthesia is performed before surgery. To accurately measure the amount of urine during surgery and in the early postoperative period, the bladder is catheterized with a Foley catheter. For the purpose of decompression, a gastric tube is installed.

An open hemicolectomy is performed through a single large midline incision in the abdominal wall. After opening the abdominal cavity, an audit is carried out; in case of oncological pathology, special attention is paid to the condition of the liver and other organs in order to detect metastases. To reduce the risk of possible spread of malignant cells, the neoplasia is covered with a damp cloth, and the arteries supplying it are ligated and crossed as quickly as possible. Between the clamps, the mesentery of the left half of the large intestine is mobilized, stitching and ligating the blood vessels.

The splenic flexure of the colon is mobilized by dividing the phrenic-colic ligament. After this, soft clamps are applied to the intestine and crossed from the proximal and distal sides. Holding the intestinal stumps on clamps, a transversorectal anastomosis is formed according to the “end to end” type (anastomosis between the transverse colon and rectum). Then the hole in the mesentery is sutured and the integrity of the parietal peritoneum is restored. In some cases (for example, with intestinal obstruction or peritonitis), interintestinal anastomosis is not indicated; surgeons create a colostomy on the abdominal wall, and the distal intestinal stump is sutured. At the end of the operation, sutures are placed on the tissue of the anterior abdominal wall, and the wound is drained.

Laparoscopic technique

In a laparoscopic hemicolectomy, the operation is performed through several small holes. Surgeons insert the first trocar near the navel, carbon dioxide is supplied through it and a video laparoscope is inserted, with the help of which a thorough examination of the abdominal cavity is performed. The second (suprapubic) trocar is inserted to the right of the midline, the third - below the right hypochondrium along the midclavicular line, the fourth - into the left lower quadrant of the abdomen. The first stage of laparoscopic left hemicolectomy consists of dissecting the fold of peritoneum in the area of the lateral left canal. To do this, using a laparoscopic clamp, the sigmoid colon is retracted to the midline and the fold is cut with laparoscopic scissors. After mobilizing the left half of the colon, the mesenteric vessels are isolated and ligated with clips, then crossed with scissors.

If the pathological process is localized in the upper part of the left half of the large intestine, the colon is removed through an incision in the abdominal wall, and resection and formation of an interintestinal anastomosis are carried out externally. After this, the colon is returned to the abdominal cavity, the incision of the anterior abdominal wall is sutured and pneumoperitoneum is restored. If the pathological process is located in the lower part of the left half of the colon (the area of the sigmoid and rectum), it is impossible to bring the affected part out. In this case, resection and anastomosis using a laparoscopic stapler are performed inside the abdominal cavity. After the anastomosis is formed, drains are installed, carbon dioxide is released from the abdominal cavity and the holes are sutured.

After left hemicolectomy

After the operation, the patient is taken to the ward of the specialized department or to the anesthesiology and intensive care department, where his condition is monitored. Infusion therapy, antibiotics and painkillers are continued, and deep vein thrombosis is prevented. After 24 hours, the patient is allowed to drink clear liquids. If the body absorbs them and the intestines begin to function, the diet is slowly expanded. Otherwise, infusion therapy is continued and parenteral nutrition is prescribed. Activation of patients begins the next day after surgery.

Sometimes in the postoperative period, patients develop intestinal paresis. To eliminate paresis, sufficient fluid therapy, adequate pain relief, correction of electrolyte imbalance and early activation are necessary. In patients with vomiting and bloating, relief may occur with the insertion of a nasogastric tube, although this alone does not eliminate ileus. The administration of narcotic drugs worsens intestinal motility, so it is better to use epidural analgesia for pain relief. Sometimes, with paresis, drug stimulation of the intestines is required, but it should be started only if other methods are ineffective and not from the first day of the postoperative period. For stimulation, prozerin is used (the use of the drug is limited by side effects), metoclopramide and alvimopan. After a few days, the drains are removed from the abdominal cavity.

After laparoscopic hemicolectomy, the sutures are removed on days 6-7, and after open surgery - on days 9-10. The patient is then discharged home. After discharge, daily short walks with a gradual increase in duration are recommended. It is allowed to go down and up the stairs; in the initial period of recovery, the patient needs the help of another person. Immediately after discharge, you can lift weights up to 5 kg; after a month, the weight of the load can be gradually increased.

Showering can be done two days after laparoscopic surgery (if the patient is able to do so). The incision sites should be washed carefully, without using soap, followed by thorough drying. With open hemicolectomy, hygiene procedures must be postponed until the sutures are removed. Working capacity is usually restored within 6-8 weeks. If a colon resection was performed for a malignant neoplasm, the patient may need chemotherapy after receiving the results of histological examination.

Complications

The development of complications is possible after any surgical operation, including hemicolectomy. Complications of this intervention include adverse reactions to anesthesia, bleeding into the abdominal cavity, toxic-infectious processes, intestinal obstruction, anastomotic leakage, deep vein thrombosis and cardiovascular events.

Cost of left-sided hemicolectomy in Moscow

One of the main factors influencing the price of the operation is the type of intervention (using laparotomy or laparoscopic access). Laparoscopic techniques are more expensive than traditional ones due to the need to use special equipment and involve specialists who have undergone appropriate training. In addition, the price of left-sided hemicolectomy in Moscow may vary depending on the order of the operation (planned or emergency), the type of medical institution (private or public), the volume of preoperative preparation, the duration of hospitalization, the presence of complications, and the list of treatment measures before and after the intervention.

Left-sided and right-sided hemicolectomy are radical operations to remove part of the large intestine from one side. Such an intervention is considered simple, but it involves a long course of rehabilitation and changes in the patient’s lifestyle, and therefore is prescribed only for vital indications.

Who is hemicolectomy indicated for?

In order for a patient to be prescribed resection of half of the intestine, serious reasons are needed. And usually these are severe pathologies that cannot be treated conservatively. Colon cancer comes first. The part of the intestine affected by cancer is immediately removed to prevent the spread of metastases.

Hemicolectomy is also indicated in the presence of polyps with malignancy in the large intestine and in the advanced stages of certain diseases: Crohn's disease, ulcerative colitis, perforation or diverticulosis of the colon, volvulus of the sigmoid colon.

Curious! In an adult, the length of the large intestine is 1.5-2 meters. It turns out that during a hemicolectomy, approximately a meter of the organ is excised.

There are no absolute contraindications to emergency hemicolectomy, because when a person’s condition is critical, one has to take risks even if there are some associated problems. A planned operation may be postponed if the patient has severe diseases of the cardiovascular system, renal or liver failure, or diabetes mellitus in the decompensated stage.

Preparing the patient for surgery

The preparatory period before hemicolectomy can be divided into two lines. The first is the necessary preoperative examinations (fluorography, ECG), tests (OAM, OAC, biochemistry) and consultations with specialists. The second is the behavior of the patient himself and his compliance with medical prescriptions.

What do doctors do

Among the specific examinations, colonoscopy is prescribed, which allows you to visually assess the condition of the part of the intestine to be removed, as well as take a piece of the mucous membrane for a biopsy to determine the cell type. If the results of the study are insufficient, an additional irrigoscopy is performed. Particularly severe conditions (colon cancer) also require computed tomography.

What does the patient do

The patient needs to start a slag-free diet 3-5 days before surgery. It will allow you to clean the intestines as thoroughly as possible to simplify the work of doctors and minimize the risk of infection during the intervention. We will have to exclude:

fat;
roast;
smoked;
sauces;
nuts;
black tea and coffee;
baked goods;
alcohol;
mushrooms;
garlic;
fresh fruits and berries.

It would be ideal to eat a salad called “Broom” or “Brush” 2 days before surgery. It will cleanse the intestinal walls of remaining toxins. The recipe is very simple: coarsely grated carrots, beets and fresh lettuce. The original recipe uses white cabbage, but it causes gas, which is undesirable before a hemicolectomy. The salad is dressed with vegetable oil and lemon juice.

How is the operation performed?

Right or left hemicolectomy can be performed in two ways: open (laparotomy) and closed (laparoscopy). The second one is preferable, because This means minimal blood loss and rapid recovery. But laparoscopy may be contraindicated or impossible if the hospital does not have endoscopic equipment.

Laparotomy

The operation is performed under general mask anesthesia. The patient lies on his back. The incision is made in the area of the anterior peritoneal wall. The affected half of the intestine is isolated and mobilized from neighboring organs and vessels (from the splenic flexure and mesenteric artery, if it is a left-sided hemicolectomy, and from the hepatic flexure and ileocolic artery, if it is a right-sided hemicolectomy).

The mobilized affected part of the intestine is clamped on both sides and cut off. The remaining stumps are stitched together with an anastomosis - a special connection for strength and restoration of patency. In some cases, the lower part of the remaining intestine is sutured, and the second part is removed through the peritoneum to form a temporary colostomy.

Laparoscopy

Laparoscopic hemicolectomy is performed under either general anesthesia or epidural anesthesia. The patient also lies on his back. An endoscope (a tube with a camera for displaying an image on a monitor) and surgical instruments are inserted into the peritoneum through punctures. The technique for intestinal mobilization and excision is approximately the same as for open surgery.

After laparoscopic hemicolectomy, several small sutures (2-3 cm each) remain, which are quickly tightened, reducing the rehabilitation period.

Why is half the intestine removed?

This is a natural question asked by people who have pathology (tumor, polyps, torsion) only in a small area of the intestine. Why not perform a hemicolectomy on the affected area only? There are several explanations for this.

The right and left halves of the colon are supplied with blood from different large arteries: from the superior and inferior mesenteric arteries, respectively. And when one of the vessels is ligated during the operation, the entire half of the intestine “dies”, and there is no point in leaving necrotic areas.
The border between the division of the large intestine into right and left parts is the transverse colon. It is mobile and easier to anastomose.
Removing half of the intestine gives better results for cancer. Because from the time of testing for tumor localization to the day of hemicolectomy, metastases may have time to spread. Therefore, part of the intestine is removed “with a reserve.”

Features of the postoperative period

Patients after laparotomy hemicolectomy are forced to remain in bed for at least 3 days to prevent the sutures from coming apart. If it was a laparoscopy, then you can and even need to get up the very next day after the operation. Both types of hemicolectomies require the installation of a drain, which is removed only after 2-3 days.

By the way! Patients who required hemicolectomy went into surgery in an already weakened or even emaciated state. Therefore, recovery will also be difficult.

After the operation you should not drink or eat. Only the next day a small amount of liquid is allowed. Liquid food is gradually introduced. Due to the reduction in intestinal length, the patient will have to follow a diet for the rest of his life. It excludes foods that require many hours of digestion (pork, lamb, beef, legumes, cabbage, some root vegetables, nuts).

Indigestion will torment the patient for about 3-4 weeks while the body adapts to new conditions. But it is advisable to avoid constipation so that too hard stool does not put pressure on the internal seams. For this purpose, the doctor usually prescribes mild laxatives.

Possible complications of hemicolectomy

Both left-sided and right-sided hemicolectomy can cause the same complications, early ones of which include injury to nearby organs (ureter, duodenum), internal bleeding, suture dehiscence, infection and inflammation of the abdominal cavity. Also, immediately after surgery, intestinal paresis (obstruction) may develop.

Attention! Some complications are dangerous because they can only be eliminated surgically. And performing another operation on the body of a weakened patient is a big risk.

If no force majeure occurred during the operation or immediately after it, and the patient was successfully discharged home, it is important to follow all the doctor’s instructions and prescriptions. Because it takes 4-6 months to fully recover from a right or left hemicolectomy. And during this time, complications may also develop: adhesions, ulcers at the anastomosis, cicatricial stenosis of the intestine, hernia.

Anemia, weight loss, decreased immunity are not complications, but typical consequences that can rarely be avoided. All this is gradually passing. After six months, we can talk about stable adaptation: both physiological and psychological. A person gains weight, gets used to a new diet, and learns to listen to the body’s feedback on changes in diet.