Right hemicolectomy
| Colectomy | |
|---|---|
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| ICD-9-CM | 45.8, 45.73 |
| MeSH | D003082 |
Colectomy ( + ) is bowel resection of the large bowel (colon). It consists of the surgical removal of any extent of the colon, usually segmental resection (partial colectomy). In extreme cases where the entire large intestine is removed, it is called total colectomy, and proctocolectomy ( + colectomy) denotes that the rectum is included.
Some of the most common indications for colectomy are:
Traditionally, colectomy is performed via an abdominal incision (laparotomy), though minimally invasive colectomy, by means of laparoscopy, is growing both in scope of indications and popularity, and is a well-established procedure as of 2006[update] in many medical centers. Recent experience has shown the feasibility of single port access colectomy.
Resection of any part of the colon entails mobilization and ligation of the corresponding blood vessels. Lymphadenectomy is usually performed through excision of the fatty tissue adjacent to these vessels (mesocolon), in operations for colon cancer.
When the resection is complete, the surgeon has the option of immediately restoring the bowel, by stitching or stapling together both the cut ends (primary anastomosis), or creating a colostomy. Several factors are taken into account, including:
An anastomosis carries the risk of dehiscence (breakdown of the stitches), which can lead to contamination of the peritoneal cavity, peritonitis, sepsis and death. A number of factors may increase the risk of anastomotic dehiscence, either partial ('leak') or complete. Basic surgical principles include ensuring a good blood supply to the opposing ends, and a lack of tension at the join. The use of NSAIDS for analgesia following gastrointestinal surgery remains controversial, given mixed evidence of an increased risk of leakage from any bowel anastomosis created. This risk may vary according to the class of NSAID prescribed.
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