Consent: Right 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 right hemicolectomy involves the removal of the terminal ileum, caecum (including the appendix), ascending colon, and hepatic flexure. An extended right hemicolectomy further involves the removal of the transverse colon as well. Right hemicolectomies can be done either open or laparoscopically, and either electively or in an emergency. In the majority of cases, an anastomosis from the ileum to the transverse colon is formed during the indexed procedure (or to the splenic flexure in an extended right hemicolectomy). In rare circumstances, a defunctioning ileostomy can also be formed, especially if there are concerns regarding the anastomosis Right hemicolectomies are most commonly performed due to bowel malignancy, however they can also be performed for other reasons for diverticular disease, bowel ischaemia, or bowel perforation. Cancer Research UK, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons Figure 1Schematic demonstrating a right hemicolectomy Complications Intra-Operative Complication Description of Complication Potential Ways to Reduce Risk Bleeding Ensure meticulous haemostasis during the procedure Damage to local structures Structures at risk include small bowel, kidney + bladder + ureter, and liver 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 Leak of intraluminal contents into the abdominal cavity through the anastomosis 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 right hemicolectomy? A right hemicolectomy is a surgical procedure that involves the removal of the terminal ileum, caecum (including the appendix), ascending colon, and hepatic flexure. This operation may be performed either openly or laparoscopically, depending on the clinical situation. What are the common indications for performing a right hemicolectomy? Right hemicolectomies are primarily indicated for bowel malignancy but can also be performed for conditions such as diverticular disease, bowel ischaemia, or bowel perforation. The procedure aims to address significant pathologies affecting the right side of the colon. What are the potential complications of a right hemicolectomy? Complications of a right hemicolectomy can include bleeding, infection, anastomotic leaks, and pain, particularly if the procedure is done openly. Awareness of these risks is crucial for effective patient management and post-operative care. How can the risk of complications be minimised during a right hemicolectomy? To reduce complications, meticulous haemostasis should be ensured during the procedure, and measures such as the use of intravenous antibiotics and optimal post-operative analgesia should be implemented. Additionally, careful handling of bowel and maintaining good blood supply at the anastomosis are vital. What is the role of anaesthesia in a right hemicolectomy? Anaesthesia plays a critical role in a right hemicolectomy, as it can lead to complications such as damage to teeth, throat, or larynx, as well as reactions to medications. A thorough pre-assessment is necessary to identify and mitigate potential anaesthetic risks. Rate This Article