Colon Resection Surgery – A Brief Introduction
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Colon resection surgery commonly used in clinical treatment can be divided into two types: part of the colon resection or subtotal colectomy. The former aims to remove part of your large bowel, it can be further divided into right hemicolectomy and left hemicolectomy, which are surgeries designed to remove the right half or left half of your large intestine. The latter is actually an operation to remove your entire large bowel and join rectum directly with your small bowel. Typically, after preoperative examination, surgeons will decide which type of surgery you should take according to the place, nature and size of the local lesions found in your colon.
What is right hemicolectomy (right colon resection)?
Right hemicolectomy includes removal of the terminal ileum, cecum, ascending colon, hepatic flexure and the right part of transverse colon. The scope of the above removal area is based on the following two aspects: one is determined by the nature of the disease. For example, diseases such as colon cancer on the right part needs to be treated to remove sufficient amount the large bowel in order to achieve desired healing results effectively. So in the operation, surgeon will also cut off the root of mesentery and ligate nutrient vessels in order to clear their lymph nodes; The other aspect of right hemicolectomy is determined by the characteristics of the right colon. There is no peritoneal covering on the back of the ascending colon, blood vessels in the right colon have fewer branches and less sufficient blood supply, the intestinal wall is relatively thin and there are more intestinal bacteria in the bowel lumen. All the above factors are not conducive to healing. Especially during inflammatory diseases and trauma, the intestinal wall will get congested with large edema, which is also detrimental to healing.
What is left hemicolectomy (right colon resection)?
Left hemicolectomy includes removal of the sigmoid colon, descending colon, splenic flexure of transverse colon, left part of transverse colon and its mesentery. Left colon has its own characteristics: First, the sigmoid colon has a complete serosa. Partial resection of the sigmoid colon could be implemented when there are benign lesions or only palliative resection of the tumor is needed. Second, the sigmoid colon has narrow lumen, when the lesions occur it is easily to lead to obstruction, therefore, surgeons are usually very prudent in choosing a left colon resection surgery.
Some questions about colon resection surgery
What are the differences between right hemicolectomy and left hemicolectomy?
The major differences between the two types of colon resection surgeries are the scope of resection, a detailed description about the differences is stated in the previous paragraph.
Why is catheter inserted before left colon resection?
Because patients who are going to take a left colon resection usually have colon obstruction associated with the disease, catheter inserted before the operation helps to make sure that the bladder is always in the empty state to reduce the damage of bladder in the operation.
What are the typical reasons to perform a colon resection surgery?
Right hemicolectomy is applied to the colon cancer of cecum, ascending colon, hepatic flexure of the colon. Generally, its indications are listed below:
- Cancer in cecum, ascending colon and hepatic flexure of colon.
- The ileocecal tuberculosis that can not be cured by non-surgical therapy, especially proliferative tuberculosis associated with obstruction, polyposis, large chorioadenoma, crohn's disease, the appendix pseudomyxoma, carcinoid tumor (diameter greater than 2 cm) and so on.
- Ileocecal intussusception that can not be reset or has intestinal necrosis . Ileocecal reverse which has intestinal necrosis can also be treated with a right colon resection surgery.
- There are serious injuries in the cecum and ascending colon which are hard to repair.
Left colon resection is applied to cancers in splenic flexure of colon and descending colon. Below are some of the indications of left hemicolectomy:
- Cancers in sigmoid colon, descending colon and splenic flexure of colon.
- Occurrence of sigmoid colon reverse with intestinal necrosis.
- Diverticulitis in sigmoid and descending colon, especially when there are bleeding and obstruction.
- Ulcerative colitis that cannot be cured by non-surgical treatment, especially when there are perforation, persistent bleeding or suspected malignant lesions.
- Multiple polyps of rectum and left colon , under the circumstance that rectal lesions are mild and can be treated with electrocautery and other therapy, Left colon resection is often operated.
What are the preoperative preparations for the patients?
1. Patients usually have complications such as anemia and hypoproteinemia, both need to be improved as much as possible before colon resection surgery. Patients are recommended to have nutrient-rich foods a week before the surgery, and switch to liquid food the day before the surgery, and blood or plasma transfusions are needed if necessary.
2. Check the functions of heart, lung, liver, kidneys and other vital organs, blood coagulation mechanism and the presence of distant metastasis.
3. Some preparations to clean the bowel, such as enema 3 to 5 days before the surgery.
4. For left colon resection, catheter will be placed before the surgery.
5. Gastrointestinal decompression tube will be placed in the morning of surgery day.
What are the postoperative treatments after colon resection surgery?
1. Venous transfusion or sometimes blood transfusion is needed.
2. Treatment of continued gastrointestinal decompression will be performed for 1 to 2 days after the surgery.
3. Treatment of anal discharge will be performed for 1 to 2 days.
4. Broad-spectrum antibiotics are used to control infections.
5. Patients can start having liquid diet 3 to 4 days after the surgery, and gradually increase the foods when the condition has improved.
6. Usually anti-cancer drugs or anti-tuberculosis drugs are used according to different type of diseases.
Note: This hub is just a summary of what I have learned about colon resection surgery, it should not be used as a precise guidance in any way. Patient is recommeded to formally consult a surgeon before the operation.