Left colectomy: Open technique
- Anthony MacLean, MD, FRCSC, FACS
Anthony MacLean, MD, FRCSC, FACS
- Clinical Associate Professor, Department of Surgery
- University of Calgary
- W Donald Buie, MD
W Donald Buie, MD
- Associate Professor of Surgery, Department of Surgery and Oncology
- University of Calgary
A left hemicolectomy includes resection of the transverse colon left of the middle colic vessels to the level of the upper rectum. A segmental left colectomy is performed when lesser resections are indicated (eg, trauma, polyp), provided the anastomosis is performed in well-vascularized bowel.
The techniques used to perform left colectomy are reviewed here. Right and extended right colectomy are presented separately. (See "Right and extended right colectomy: Open technique".)
The colon and rectum occupy the retroperitoneal and intraperitoneal spaces, in close approximation to solid organs (figure 1). The ascending and descending colon are retroperitoneal, while the transverse colon, which extends from the hepatic flexure to the splenic flexure, is intraperitoneal. The sigmoid colon continues from the descending colon, ending where the teniae converge to form the rectum.
Arterial supply — The arterial supply of the left colon has few profuse anastomoses and collateral circulations. The middle colic artery (MCA) and the inferior mesenteric artery (IMA) provide the principle blood supply to the left colon (figure 2). The marginal artery of Drummond and the arc of Riolan provide collateral blood vessels. Typically, the blood supply of the transverse colon is excellent provided the marginal artery is not damaged. Variability in the arterial anastomoses occurs, which is an important point when performing a segmental resection. The two most tenuous sites and the corresponding arterial supplies are the splenic flexure (Griffith's point) and distal descending colon (Sudeck's point). (See "Overview of intestinal ischemia in adults", section on 'Intestinal vascular anatomy'.)
Venous and lymphatic drainage — The venous drainage of the left colon is through the inferior mesenteric vein (figure 3). The lymphatic drainage flows along the left colic artery and the sigmoid vessels to the inferior mesenteric vessels (figure 4).
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- COLON ANATOMY
- Arterial supply
- Venous and lymphatic drainage
- PREOPERATIVE EVALUATION AND PREPARATION
- ABDOMINAL EXPLORATION
- EXTENT OF RESECTION
- MOBILIZING THE LEFT COLON
- Lateral-to-medial approach
- Medial to lateral approach
- COLOCOLONIC ANASTOMOSIS
- Hand-sewn anastomosis
- Stapled anastomosis
- - End-to-end
- - Side-to-end
- - Functional end-to-end
- Leak testing
- Preventing complications
- POSTOPERATIVE CARE AND FOLLOW-UP
- SUMMARY AND RECOMMENDATIONS