Hemicolectomy in Thailand

The last part of the gastrointestinal system is referred as the colon and it is 5-6 cm long. It is ‘U’ shaped and it starts from the distal part of the small intestine and is connected to the rectum and anus. It absorbs the fluids, processes the metabolic waste products, and eliminates through the rectum and anus. The removal of the colon is called colectomy.

There are different types of colectomies such as complete colectomy,  right hemicolectomy, left hemicolectomy, sigmoid colectomy, and proctocolectomy. The surgical removal of the left side of the colon (descending colon) is called left hemicolectomy surgery. The surgical removal of the cecum, ascending colon, and the hepatic flexure (right side of the colon) is called as the right hemicolectomy surgery.

Some of the conditions that require complete colectomy or hemicolectomy surgery include the following:

• Colon cancer
• Crohn’s disease
• Blockage of the colon
• Precancerous polyps
• Hereditary polyps
• Benign tumours
• Irritable bowel syndrome (IBS)
• Gastrointestinal bleeding
• Bowel twisting and obstruction
• Ulcerative colitis
• Appendicitis with inflammation of the cecum
• Right-side colonic diverticular disease (diverticulosis)

A hemicolectomy procedure can be performed as a laparoscopic or open surgery. The type of the surgery to be performed is decided by the surgeon during the evaluation and the decision depends on the age and the condition of the patient.

Sometimes the laparoscopic procedure can also be turned into open surgery, depending on the feasibility of the procedure with respect to safety and accuracy. Overall, the following parameters decide whether a laparoscopic or an open surgical procedure will be performed:

• Age
• Diagnosis
• Medical history
• Personal preference

You will be informed by your surgeon about the type of surgical procedure that you will benefit you the most. You will be taken to the operating room, and blood pressure and breathing will be monitored.

Left Hemicolectomy Procedure

You will be positioned in lithotomy Trendelenburg (modified Lloyd-Davis) position and your both arms will be abducted on arm boards. The legs will be placed in stirrups and soft padding will be placed underneath to prevent pressure and injuries to the skin and nerves. 

After positioning, you will be given general anaesthesia so that you do not feel any pain during the procedure. Sometimes, a peripheral nerve block may also be given to control pain during and after the surgery.

• In laparoscopic left hemicolectomy surgery, three to five tiny incisions are made in your belly, and a laparoscope is inserted from one of the incisions. Your surgeon can visualize the inside of your belly on the monitor by the camera of the laparoscope.
• The laparoscope has a light that will aid in viewing. The other medical instruments required for the surgery will be inserted through the other incisions. Gas will be used to expand the belly and for clear viewing. A two to three inches cut will be made and the colon will be taken out for easy excision of the part and the ends of the remaining colon will be rejoined. A laparoscopic surgery is a minimally invasive procedure that ensures faster recovery as fewer traumas occur to the organs. It causes less pain as compared to open surgery.
• In open surgery, a six to eight-inches long cut is made on your belly, and the diseased part of the colon is taken out using the surgical instruments. Lymph nodes are also removed. After removal, the healthy parts of the intestine are joined at the ends using stitches or they are stapled together. The joining of the parts of the intestine is called anastomosis. If there is no healthy part of the colon, then an opening called stoma is made in the belly with the remaining colon. This stoma will be connected to a drainage bag in which the metabolic wastes get collected. This drainage bag should be cleaned manually on a daily basis.
• The stoma can be permanent or short-term, based on the condition of the colon. Despite the trauma, an open procedure is the safest and effective procedure. The total procedure can be completed in one to four hours.
  
  

Right Hemicolectomy Procedure

You will be positioned in the supine position initially and later you may be taken to the Trendelenburg position (lying by facing upwards on a tilted bed with pelvis higher than the head).

After positioning, you will be administered general anaesthesia and an additional epidural block for pain management. The catheter will be placed for monitoring the urine output during and after the procedure. The laparoscopic right hemicolectomy procedure or open surgery can be performed, depending on the condition of the colon.

• In the minimally invasive laparoscopic right hemicolectomy procedure, small incisions are made in your belly and a laparoscope will be inserted through the incisions. The right side of the colon and last part of the small intestine will be removed during the procedure along with the lymph nodes. The remaining part of the small intestine and the colon are joined with sutures or staples. The excised part of the colon is removed by making an incision in the belly.
• In the open surgery for diverticulosis and other conditions, a long cut is made on the belly and the procedure is carried out by opening the abdomen. The right side of the colon is cut and removed and the remaining parts of the intestine are joined by sutures or surgical staples. Usually, this procedure may not require a stoma outside the belly. The procedure is completed in two to three hours.

During the hemicolectomy procedure, your surgeon may take any of the following approaches:

• Remaining parts of the colon are rejoined (anastomosis)
• Stoma may be created on belly (colostomy)
• Joining of the small intestine and the anus (ileoanal anastomosis)

• A hospital stay of two to three days may be required for a laparoscopic surgery and a three to seven days stay is required for an open surgery.
• You will be placed on an intravenous drip for 24 hours and nothing will be given by mouth.
• You will be allowed to take clear liquids after 24 hours of the procedure.
• A catheter will be placed for draining the bladder, and it will be removed after a few days.
• The sutures and staples on the belly will be removed after 14 days of the surgery.
• You should avoid heavy lifting and heavy physical activities for up to six weeks.
• You should avoid spicy foods and take small and frequent meals.
• You should walk after 24 to 48 hours of the procedure to avoid respiratory problems.
• Depending on the progress of your recovery and the evidence of bowel excretion, you will be discharged.
• You should visit the surgeon as per the scheduled follow-up visits so that the condition of the bowel can be assessed.