Right hemicolectomy

Why are we operating?

Resection of the right colon for cancer: take the vessels at their origin, take the nodes with them, and join ileum to transverse colon.

Indication: Right-sided colon cancer; caecal volvulus; some right-sided Crohn's complications.

The operation in 4 steps

1. 01Access and staging the abdomen

   Ports placed, the liver and peritoneum inspected before any dissection commits the operation.

2. 02Vascular pedicle first

   The ileocolic pedicle is lifted, windows opened either side, and the vessels clipped and divided at their origin from the superior mesenteric vessels.

3. 03Mobilisation

   The right colon is freed medial-to-lateral off the retroperitoneum, then the hepatic flexure taken down.

4. 04Resection and ileocolic anastomosis

   Terminal ileum and colon divided at healthy margins and an ileocolic anastomosis fashioned, commonly stapled side-to-side.

Anatomy you need

Cecum to mid-transverse colon and the terminal ileum that joins the anastomosis; the ileocolic pedicle is the operation.

What can go wrong

• Anastomotic leak

  Day 3–7: tachycardia, fever, abdominal pain, ileus that fails to resolve, or subtle deterioration that 'doesn't add up'.

• Postoperative bleeding

  Tachycardia first, hypotension late; falling urine output; a distending abdomen or rising drain output.

• Postoperative ileus

  Distension, absent flatus, intolerance of diet, and quiet bowel sounds in the days after abdominal surgery.

• Surgical-site infection

  Wound erythema, warmth, discharge, and pain out of proportion, typically from postoperative day 4–7.