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03 / Colorectal Surgery · laparoscopic

Right hemicolectomy

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.

Part of Colorectal Surgery →4 stages4 complications to knowlaparoscopic
A laparoscopic theatre set up for colonic resection
Dr.jayesh amin · CC BY-SA 3.0

Read the imaging first

Endoscopy
Colonoscopic view of a colonic polyp
Colonoscopy · the adenoma before it is a cancer

On the tray for this operation

Test yourself on the tray

Stage

1 / 4

Access and staging the abdomen

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

🔧 Trocar

Watch for: Missed peritoneal disease if inspection is rushed

Why are we operating?

Right hemicolectomy removes the right colon inside its embryological envelope with the lymph nodes that drain it: for caecal and ascending colon cancer it is the curative operation, defined not by centimetres of bowel but by the ileocolic pedicle whose territory and lymphatics it harvests. The join it leaves, ileum to transverse colon, is the best-perfused anastomosis in colorectal surgery.

Pulls toward surgery

Caecal or ascending colon cancerRight-sided polyps beyond endoscopic reachTerminal ileal Crohn's complicationsRight-sided emergencies: bleeding, perforation, appendiceal tumours

Gives the team pause

Metastatic disease reframing intentInvasion into duodenum or vessels (en bloc territory, not blunt persistence)Emergency physiology bending the elective plan

Shared foundations

Embryological planes & mesenteric envelopes

The idea that made colorectal cancer surgery an oncologic discipline: the gut grew inside mesenteric envelopes, and dissecting the bloodless plane around an intact envelope removes the cancer with its lymphatic field. Total mesorectal excision is this idea applied to the rectum; every colonic resection is the same idea at a different address.

Understand it once, in the specialty hub

What the surgeon is thinking

  • Access and staging the abdomen

    Why does the operation start by looking everywhere but the tumour?

    Because findings change the plan: liver surfaces, peritoneal deposits and the primary's fixity are staged by eye and hand before anything is committed. An operation that discovers incurability after dividing the pedicle has answered the questions in the wrong order.

  • Vascular pedicle first

    Why take the ileocolic vessels at their origin?

    The lymphatics run with the artery: dividing the pedicle at the superior mesenteric origin harvests the nodal chain as one packet, which is the oncologic content of the operation. The bowel resection is almost a by-product of the vascular one.

  • Mobilisation

    What is the plane being developed, and what lives behind it?

    The embryological fusion plane between the colon's mesentery and the retroperitoneum: opened correctly it is avascular and the colon lifts like a page. Behind it lie the structures the plane protects, the duodenum, the gonadal vessels and the right ureter, injured mainly by surgeons who left the plane.

  • Resection and ileocolic anastomosis

    Why is the ileocolic join the forgiving one?

    Both ends carry generous supply, the ileum's arcades and the middle colic's territory, and the join lies without tension once mobilisation is done: leak rates here are the lowest in colorectal surgery. Forgiving is not unconditional: the three requirements (supply, tension, patient) still apply.

Decision points

  • Stapled side-to-side or handsewn end-to-end for the ileocolic anastomosis?

    • Stapled side-to-side

      Fast, reproducible, wide lumen: the contemporary default in most hands.

    • Handsewn

      Equivalent in trained hands, cheaper, and the technique that must exist for when staplers cannot: mismatched ends, tissue quality, resource settings.

    The evidence calls them equivalent, which is itself the lesson: technique choices matter less than the anastomotic conditions. A surgeon should own both, and the reason for today's choice should be sayable.

  • The tumour is stuck to the duodenum. What does 'stuck' change?

    • En bloc resection of the adherent portion

      Adhesion is treated as invasion: peeling a tumour off the duodenum converts a curable operation into a contaminated field.

    • Biopsy, bail and refer

      When the required resection exceeds tonight's team or consent: an honest pause outranks an unplanned pancreatico-duodenal adventure.

    The oncologic rule is never to breach the tumour: adherent structures come with the specimen or the operation changes shape. Knowing the difference between what should be done and what should be done here, now, by this team, is senior judgement.

Leaving the OR

The handoff

Procedure
Right hemicolectomy for caecal adenocarcinoma, stapled ileocolic anastomosis
Findings
No peritoneal or liver disease seen; pedicle taken at origin
Continuity
Restored; no defunctioning needed
Watch for
Day 5-7 leak window; ileus vs obstruction; the histology report as the next decision point

A fictional educational patient, handed over the way real ones are.

The postoperative course

  1. POD 0-1Enhanced recovery: early feeding, early walking, lines and catheters out on schedule rather than sentiment.
  2. POD 2-4Bowel function returning; the ileus that lingers is watched with the leak differential in mind.
  3. POD 5-7The anastomotic window: new AF, tachycardia or CRP reversal here is a leak until proven otherwise.
  4. Week 2-4Histology at MDT: nodal status decides adjuvant chemotherapy, and the operation's story hands over to oncology's.

Watch it done

Find Right hemicolectomy videos on YouTube

What can go wrong

Anastomotic leakPostoperative bleedingPostoperative ileusSurgical-site infection
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