This information is to be used as a guide in conjunction with your surgical consultation. Right hemicolectomy is the operation to remove part or all of the right side of the colon. Indications include colon cancer and inflammatory conditions such as Crohns disease and diverticulitis.

What is a Right Hemicolectomy?

During the operation the right side of the colon and the last part of the small bowel are removed. This involves taking away the blood vessels and lymph nodes to that part of the bowel. The two ends of healthy bowel are then re-joined together (anastomosed) by sutures or staples. The wound on the abdomen maybe closed with clips, stitches or ‘skin glue’.

This type of surgery does not usually require the formation of a stoma i.e. ileostomy or colostomy. The operation time may vary but is usually around 2 hours. The section of bowel that is removed is sent for histopathology examination, the results are usually available within 5 days of the operation.

There are two ways that surgery can be performed. ‘Open’ (Laparotomy) where the surgeon makes a larger incision in the abdomen to remove the affected area of bowel and ‘Laparoscopic’ (Keyhole), where a number of small incisions allow manipulation of specialist instruments guided by a camera. Laparoscopic technique is used whenever possible.

Recognised benefits of keyhole (Laparoscopic) surgery include:

• Shorter recovery time and earlier discharge
• Reduced post operative pain
• Minimised scarring
• Early return of bowel function

The approach used often depends on your general health and previous medical and surgical history. It is important to note that if you are to undergo laparoscopic surgery, sometimes operations may begin as laparoscopic but then convert to an open procedure for technical reasons.

Bowel cleansing prep is not required for right hemicolectomy; you should have clear fluids only for 24 hours prior to the operation and a fast of 6 hours pre op for a general anaesthetic (specific instructions will be given).

What are the risks?

There are risks associated with any abdominal operation. Pre-operative assessments of heart and lung conditions are made as well as any coexisting medical conditions. During the hospital admission patients wear stockings and are given small injections to prevent thrombosis (blood clots).

Bleeding is very rare in this type of surgery; but if significant a blood transfusion may be required.

Wound infections can occur in any form of bowel surgery, open or laparoscopic. Wound infections rarely cause serious problems but may require treatment with antibiotics.

Occasionally there maybe a leak at the new join in the bowel, this is called an anastomotic leak; the risk of leakage is greater in patients who have Crohns disease and in patients who take steroid medication. If a leak occurs sometimes this can be managed with antibiotics and/or a drain placed through the abdominal wall, (usually performed in the X-ray department). If the leak is larger and peritonitis develops another operation may be necessary and a stoma (ileostomy) formed.

Sometimes the bowel may take longer than normal to start working, this is known as ileus. Patients may develop abdominal distension and vomiting, if this happens it is treated with a period of bowel rest with continued intravenous fluids and sometimes a tube passed via the nose to the stomach (nasogastric tube).

When the bowel doesn’t start working there maybe a kink, twist or an adhesion causing a blockage, this is known as obstruction. Patients may develop colicky abdominal pains, abdominal distension and vomiting; this is treated with a period of bowel rest with continued intravenous fluids and sometimes a nasogastric tube. In most cases the obstruction settles spontaneously, occasionally an operation is required to relieve the blockage.

After the operation

• Patients will have an intravenous drip until a normal oral fluid intake is resumed.
• A urinary catheter is normally kept in place for 24 hours.
• Occasionally an abdominal drain is used (small tube passing through the abdominal wall).
• Pain relief can be given intravenously, usually with a PCA (patient controlled analgesia) or via epidural and oral medication; your anaesthetist will discuss this with you.
• Patients are allowed to eat and drink as tolerated and their condition allows.
• Patients are encouraged to mobilize as soon as possible after the operation.
• Hospital stay is usually 2-5 days for keyhole surgery and 5-7 days for open surgery.
• Following discharge patients are encouraged to keep mobile, you should avoid moderate to heavy lifting and over exertion for about 6 weeks. Patients can normally resume driving after about 2 weeks when comfortable.
• A follow up consultation 6-8 weeks post op to review progress.

Possible longer-term complications of abdominal surgery

• Incisional hernia: Presents as bulge in abdominal wall close to the wound site. This occurs in 10-15% of abdominal wounds and usually appears within the first year following surgery but can be later. They maybe small with minimal symptoms but can sometimes cause pain/discomfort or increase in size over time.
• Adhesions (scar tissue): Scar tissue that forms between tissues and organs after any operation. Typically, scar tissue begins to form within the first few days of surgery, but they may not produce symptoms for months or years. In some cases these can cause complications such as pain, affect the activity of the bowel leading to hospital admission or further surgery.

• Pain: Acute postoperative pain usually settles within a couple of weeks with most patients being quite comfortable. Some patients may experience residual pain that may require further review; options for treatment are based on understanding the pain mechanisms involved.