Right and extended right colectomy: Open technique
- Andrea Bafford, MD
Andrea Bafford, MD
- Assistant Professor Surgery
- University of Maryland School of Medicine
Right colectomy refers to the resection of a portion of the distal ileum, cecum, ascending colon, and proximal to mid-transverse colon. Extended right hemicolectomy refers to extension of the distal resection margin to include the distal transverse colon up to the splenic flexure.
The techniques used to perform right and extended right colectomy are reviewed here. Left colectomy is presented separately. (See "Left 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 right colic artery and the ileocolic artery provide the principle blood supply to the right 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'.)
- Sonoda T, Milsom JW. Section 5: Gastrointestinal tract and abdomen. Chapter 34: Segmental colon resection.ACS Surgery: Principles and Practice http://www.acssurgery.com/acs/chapters/ch0534.htm (Accessed on November 07, 2011).
- Neutzling CB, Lustosa SA, Proenca IM, et al. Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev 2012; 2:CD003144.
- McLeod RS, Wolff BG, Ross S, et al. Recurrence of Crohn's disease after ileocolic resection is not affected by anastomotic type: results of a multicenter, randomized, controlled trial. Dis Colon Rectum 2009; 52:919.
- Meagher AP, Wolff BG. Right hemicolectomy with a linear cutting stapler. Dis Colon Rectum 1994; 37:1043.
- Sajid MS, Siddiqui MR, Baig MK. Single layer versus double layer suture anastomosis of the gastrointestinal tract. Cochrane Database Syst Rev 2012; 1:CD005477.
- COLON ANATOMY
- Arterial supply
- Venous and lymphatic drainage
- INDICATIONS FOR COLON RESECTION
- PREOPERATIVE EVALUATION AND PREPARATION
- ABDOMINAL EXPLORATION
- EXTENT OF RESECTION
- Right colectomy
- Right extended colectomy
- Mesenteric resection
- Omental resection
- MOBILIZING THE RIGHT COLON
- Lateral to medial approach
- Medial to lateral approach
- ILEOCOLONIC ANASTOMOSIS
- Stapled side-to-side functional end-to-end anastomosis
- Stapled end-to-side anastomosis
- Hand-sewn end-to-end anastomosis
- ABDOMINAL CLOSURE
- Preventing complications
- SUMMARY AND RECOMMENDATIONS