Consent: Left Hemicolectomy - Podcast Version 0:00 / 0:00 1x 0.25x 0.5x 0.75x 1x 1.25x 1.5x 1.75x 2x This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent. Overview of Procedure A left hemicolectomy involves the removal of the splenic flexure, descending colon, and a portion of the sigmoid colon. Left hemicolectomies can be done either open or laparoscopically, and either electively or in an emergency. In the majority of cases, an anastomosis from the transverse colon to the sigmoid colon is formed during the indexed procedure; in uncommon circumstances, a defunctioning ileostomy may be formed, especially if there are concerns regarding the anastomosis Left hemicolectomies are most commonly performed for bowel malignancy, but can also be performed for diverticular disease, bowel ischaemia, or bowel perforation. Left hemicolectomies are slightly less common then right hemicolectomies, as fewer bowel cancers occur in the descending colon compared to the ascending colon Cancer Research UK, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons Figure 1Schematic demonstrating a left hemicolectomy Complications Intra-Operative Complication Description of Complication Potential Ways to Reduce Risk Bleeding Ensure meticulous haemostasis during the procedure; careful dissection at the splenic flexure off the spleen Damage to local structures Structures at risk include small bowel, kidney + bladder + ureter, and spleen; if the splenic flexure is densely adherent to the spleen, splenectomy may be required Anaesthetic risks Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications. Forms part of anaesthetic pre-assessment Early Complication Description of Complication Potential Ways to Reduce Risk Pain Pain is often worse in open procedures, compared to laparoscopic Optimal post-operative analgesia, including epidurals or rectus sheath catheters Infection Includes both wound infections and intra-abdominal collections, as well as respiratory or urinary tract infections post-operatively Intravenous antibiotics at induction, minimisation of faecal contamination during procedure, wound irrigation at closure Anastomotic leak Good blood supply at the anastomosis, bowel not under tension Ileus Minimise contamination and bowel handling, correct any electrolyte abnormalities post-operatively Scarring Use of laparoscopic surgery if possible to result in a smaller scar Re-Operation Any complication may result in the return to theatre in the immediate post-operative period DVT or PE, Myocardial Infarction, Stroke, or Mortality As with any major surgery, whilst these events are uncommon, important to be aware of Adequate pre-optimisation and anaesthetic assessment, peri-operative prophylactic LMWH, high-dependency level care post-operatively Late Complication Description of Complication Potential Ways to Reduce Risk Adhesions Attempt laparoscopic approach if possible, avoid excess tissue disruption Stoma complications Includes stoma retraction, prolapse, or high stoma output, if a stoma is formed Incisional hernia Ensure fascia is closed tightly, using a small bites technique Frequent questions What is a left hemicolectomy? A left hemicolectomy is a surgical procedure that involves the removal of the splenic flexure, descending colon, and part of the sigmoid colon. This operation can be performed either laparoscopically or through an open approach, and it is commonly indicated for conditions such as bowel malignancy and diverticular disease. What are the common complications of a left hemicolectomy? Common complications include bleeding, infection, and anastomotic leaks. These risks can be mitigated through careful surgical technique, appropriate antibiotic use, and ensuring good blood supply at the anastomosis. What structures are at risk during a left hemicolectomy? During a left hemicolectomy, adjacent structures at risk include the small bowel, spleen, kidney, bladder, and ureter. Careful dissection and management of adhesions are essential to minimise potential damage to these structures. What are the indications for performing a left hemicolectomy? Indications for a left hemicolectomy primarily include bowel malignancy, diverticular disease, bowel ischaemia, and bowel perforation. This procedure is less common than right hemicolectomy due to the lower incidence of cancers in the descending colon. How can the risk of post-operative complications be reduced after a left hemicolectomy? To reduce post-operative complications, optimal analgesia, minimisation of faecal contamination, and careful handling of the bowel during surgery are crucial. Additionally, pre-operative optimisation and appropriate post-operative care can significantly lower the risk of issues such as infections and adhesions. Rate This Article