Right Hemicolectomy

A right hemicolectomy, also known as a right colectomy, is a surgical procedure in which the right (ascending) part of the colon is removed. This operation is generally performed to treat diseases affecting this part of the colon.

A right hemicolectomy is typically performed for one or more of the following reasons:

Colon Cancer: This is the most common indication for a right hemicolectomy. If cancer is located in the ascending colon, removing this part of the colon can be a primary treatment.
Crohn’s Disease: Patients with complications from Crohn’s disease affecting the right colon may require surgery.

Diverticulitis: Though less common in the ascending colon, severe cases of diverticulitis may necessitate a right hemicolectomy.
Bowel Obstruction: A blockage in the right colon can sometimes be relieved through surgery if it does not resolve with conservative treatment.
Precancerous Polyps: Polyps that are too large or numerous to remove during a colonoscopy and have the potential to turn into cancer may be treated with a right hemicolectomy.
Ischemic Colitis: Restricted blood flow can cause part of the colon to become inflamed or die, potentially requiring surgical intervention.
Benign Tumours: Large or symptomatic benign tumours may also be indications for this surgery.

Symptoms

The symptoms leading to a right hemicolectomy largely depend on the underlying condition, but may include:

Persistent abdominal pain
Changes in bowel habits
Weight loss
Gastrointestinal bleeding
Bowel obstruction symptoms such as nausea, vomiting, and severe constipation
In the case of cancer, there may be additional symptoms such as fatigue and anaemia

Diagnosis

The diagnosis of conditions that might require a right hemicolectomy typically involves a combination of:

Clinical Evaluation: Including a patient’s history and a physical examination.
Colonoscopy: Allows for direct visualisation and biopsy of colon lesions.
Imaging: Such as CT scans or MRIs to visualise the abdomen and assess the colon and other structures.

Treatment Options

A right hemicolectomy is primarily a surgical procedure, and the approach can vary:

Laparoscopic Surgery: Minimally invasive surgery with several small incisions, using special instruments and a camera to guide the surgery.
Open Surgery: Involves a single, long incision in the abdomen to access the colon.
Robotic Surgery: A form of minimally invasive surgery that is assisted by robotic technology, providing the surgeon with enhanced precision.

Recovery

Recovery from a right hemicolectomy depends on several factors, including the patient’s overall health, the reason for the surgery, and whether it was performed as an open or minimally invasive procedure.

Hospital Stay: Usually ranges from a few days to a week.
Diet: Patients typically start with a liquid diet postoperatively and gradually advance to solid foods as bowel function returns.
Activity Level: Activity is usually limited immediately after surgery, and patients are encouraged to gradually increase activity as tolerated.

Risks and Complications

As with all surgeries, a right hemicolectomy carries potential risks and complications:

Infection
Bleeding
Blood clots
Hernia at the incision site
Leakage where the two ends of the bowel were reconnected (anastomotic leak)
Adverse reactions to anaesthesia
Bowel obstruction due to scar tissue (adhesions)

Postoperative Care

Monitoring: For signs of infection and complications.
Pain Management: Typically involves medications.
Follow-Up: Visits with the surgeon to monitor recovery.
Stoma Care: If the surgery results in a colostomy or ileostomy, patients will need education on stoma care.

The long-term outcome after a right hemicolectomy will depend on the underlying pathology. For cancer patients, prognosis will depend on the stage of the cancer and whether it has spread. For benign conditions, removal of the affected part of the colon often leads to relief of symptoms and a return to normal activities. Patients may experience changes in bowel habits, but these often improve over time. Regular follow-up with a healthcare provider is essential to monitor for any long-term issues or complications.

Dr Devesh Kaushal is a Specialist General Surgeon and a Fellow of the Royal Australian College of Surgeons (FRACS).

Dr Kaushal offers 15+ years of experience and holds a Master of Surgery Degree, as well as being fully certified in gastroscopy and colonoscopy by the Gastroenterology Society of Australia (GESA).

Dr Kaushal takes an empathetic, warm-hearted and friendly approach to patient care and is completely dedicated to patient outcomes.

He consults and operates across Souther-Western Sydney.

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