Diverticulitis<\/a><\/p>\nIschemia<\/p>\n
Perforation<\/p>\n
<\/p>\n
Incision<\/h4>\n
Longitudinal midline – this is the most common incision in right hemicolectomy and runs up and down usually from just above the symphysis pubis (pubic bone) to above the umbilicus (belly button).<\/p>\n
Transverse lower right quadrant – this incision is used less commonly but gives good exposure at the ileocecal region (where the small bowel turns into the large bowel).<\/p>\n
Surgical Details of Right Hemicolectomy<\/h4>\n
1. An incision is made in the skin with a #10 blade<\/p>\n
2. Bovie cautery is used to dissect the subcutaneous fascia<\/p>\n
3. The scalpel is used to incise the fascia in the midline (usually above the umbilicus) between the rectus muscles.<\/p>\n
4. The peritoneum is grasped between two forceps and palpated to insure that bowel is not present<\/p>\n
5. The peritoneum is incised with a Metzenbaum scissors.<\/p>\n
6. If purulent or bloody peritoneal fluid is returned, a culturette swab is obtained times two.<\/p>\n
7. The balance of the incision is opened.<\/p>\n
8. Bookwalter, Balfour, or Thompson retractors are used to provide exposure<\/p>\n
9. In right hemicolectomy, an incision is made at the peritoneal reflection lateral to the cecum.<\/p>\n
10. Dissection upwards towards the hepatic flexure (area of the colon next to the liver) from this initial incision is performed, usually with the Bovie Cautery.<\/p>\n
11. The hepatic flexure of the colon is “taken down” or released from its retroperitoneal attachments.<\/p>\n
12. Care must be taken in ligating the small blood vessels in the hepatic-colic ligament (connective tissue between the colon and the liver).<\/p>\n
13. Care must be taken whne doing a right hemicolectomy to not injure the 2nd and 3rd part of the duodenum, which is directly deep to the hepatic flexure of the colon.<\/p>\n
14. Once the retroperitoneal attachments are freed the right colon can be lifted toward the midline.<\/p>\n
15. The right ureter may be visualized running under the elevated right colon.<\/p>\n
16. The area of transection in the transverse colon is selected by palpating for the middle colic vessels and its right branches.<\/p>\n
17. The omentum is freed off the area of resection of the colon by using hemostats or Kelly clamps to cross-clamp and then ligate with 2-0 silk ties<\/p>\n
18. A hemostat or Kelly clamp is used to open a window in the mesentery just beneath the edge of the bowel on the mesenteric side at the planned area of transection.<\/p>\n
19. A one half of a GIA bowel stapler is placed through the just formed mesenteric window and one half is placed over the bowel wall.<\/p>\n
20. The GIA stapler is closed and fired transecting the bowel wall.<\/p>\n
21. The transection area of the terminal ileum is selected and a hemostat or Kelly clamp is used to open a small window in the mesentery.<\/p>\n","protected":false},"excerpt":{"rendered":"
Right Hemicolectomy Open Technique Indications Malignancy (most often the cancer is an adenocarcinoma) Diverticulitis Ischemia Perforation<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[15,5372],"tags":[5291,6159,3379,5127,5290,5287,4968,5288,5289],"yoast_head":"\n
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