Right colectomy
Right colectomy
Operation
– Right colon cancer
– Perforation of the right colon
– Right colon polyp(s)
– Right colon ischemia
– Benign tumor of the right colon
– Volvulus of the right colon
A right colectomy is the removal of the right colon (first part of the colon) up to the transverse colon (second part of the colon) and restoring the continuity by connecting the ileum (last part of the small intestine) to the transverse colon. The procedure is performed under general anesthesia.
In the first stage of the procedure, the colon is freed from its attachments all the way to the middle of the transverse part of the colon.
During this phase, the surgeon must pay attention not to injure the duodenum (first part of the bowel) and the right ureter (tube that carries urine from the kidney to the bladder).
In the second stage of the procedure, the colon together with the surrounding fatty tissue containing the blood vessels and lymphatic tissue (lymph nodes) of the colon are removed , ” en block ” (in one piece).
The tumor with its fatty envelope is removed from the abdominal cavity through an incision in the lower abdomen( pubic area), at the level of the umbilicus or in selected cases after consultation with the patient through the vagina.
If the extraction is performed through the vagina, the patient should abstain from sexual relations for 4 weeks. Extraction of the colon through the vagina does not alter sexual pleasure.
The removed lymphoid tissue is examined for the presence of tumor cells in the lymph nodes. The presence of tumor cells in lymph nodes is an important factor when deciding whether or not to administer adjuvant chemotherapy.(chemotherapy after surgery).
In the third stage continuity is restored by making a anastomosis (suture) between the small intestine and the transverse colon so that faeces still are evacuated through the anus.
The anastomosis/suture/suture is usually performed in the abdominal cavity with keyhole surgery.
Advantages:
Laparoscopy may not be possible when:
Factors that increase the risk of complications:
Incidence : 1,8 – 8 %
A stoma is a surgical procedure in which the bowel is sutured through the abdominal wall earth the skin so that the fecal matter is discharged via in a pouch / bag attached to the skin.
Incidence : < 9 % after laparotomy for abdominal surgery
Adhesions of the small intestine are the main causes of postoperative obstruction. If the obstruction does not clear up spontaneously, surgery may be necessary. Laparoscopic surgery requires less traumatic manipulation of the bowel and causes fewer adhesions. The risk of obstructions is much lower after laparoscopy (keyhole surgery) than after laparotomy (open abdominal surgery).
Incidence : 1,1 – 2,3 %
Incidence : 10 %
Wound infection is common after colon surgery because the colon contains millions/billions of bacteria that may infect the wound. The risk is higher in open surgery than in laparoscopic surgery.
Among other factors, obesity, malnutrition, diabetes and corticosteroids increase the risk of an infection.
Laparoscopy : incidence : 7 %*
Open laparotomy : incidence : 22,4%*
Wound infection, obesity, malnutrition, diabetes and chronic use of corticosteroids are factors that increase the risk of incisional hernia.
Patients at risk are those requiring anticoagulation medication for cardiovascular disease or those with bleeding disorders.
In most cases, the bleeding stops spontaneously. Treatment by endoscopy (colonoscopy) is rarely necessary.
Incidence : 6,8 %*
After abdominal surgery, the bowel may temporarily lose its ability to contract and expel food, this is called an ileus.
The bowel dilates and the patient can no longer feed. An ileus manifested by discomfort due to the dilated abdomen that may or may not be accompanied by vomiting.
The bowel dilates and the patient can no longer feed. An ileus manifested by discomfort due to the dilated abdomen that may or may not be accompanied by vomiting.
Treatment consists of resting the bowel, inserting a nasogastric probe through which the stomach and bowel are decompressed and stopping morphine analgesics,. The bowel spontaneously returns to normal after 1 to 10 days. On average, postoperative ileus prolongs hospitalization by 4 days. Ileus is more common after laparotomy than after laparoscopy.
In normal conditions, pain is well controlled with paracetamol (Dafalgan®), NSAIDs (anti-inflammatories) or morphine (Tradonal®…) and pain symptoms diminish over time.
If certain symptoms seem abnormal to you contact your doctor.
If this is not possible, you can contact your surgeon.
If you are unable to contact your GP or your surgeon, go to the emergency department at St Elizabeth Hospital in Uccle.
Upon resection (removal) of the right colon, the length of the colon is reduced.
This reduces the postoperative ability to reabsorb water from the stools, so bowel movements may be softer and even liquid immediately after surgery (diarrhea).
The remaining colon has enough length to adapt and absorb more water, in subsequent weeks and months the stools can return to a normal consistency.
Right colectomy has no direct impact on sexual function either in men or women.