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Right and extended right colectomy: Open technique

Topic Outline



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 to include the left transverse colon up to the splenic flexure.


Malignant and benign diseases are indications for a right colectomy and include a right colon cancer (eg, cecum, ascending colon), appendiceal cancer, right-sided diverticulitis, inflammatory bowel disease, ischemia/infarction, infection, trauma, and cecal volvulus. The indications for an extended right colectomy include a cancer located at the hepatic flexure to the mid-transverse colon.


Mechanical bowel preparation — Based upon the results of a systematic review that included 184 trials and 5805 patients, preoperative mechanical bowel preparation (MBP) is unnecessary for patients undergoing elective open right-sided colon surgery [1]. However, recent data suggest that preoperative MBP combined with oral antibiotics reduces surgical site infection following elective colorectal surgery [2]. The role of oral antibiotics alone, however, is yet to be determined.

Prophylactic antibiotics — The use and timing of intravenous antimicrobial prophylaxis for prevention of surgical site infection following gastrointestinal procedures is discussed separately (table 1 and table 2). (See "Control measures to prevent surgical site infection following gastrointestinal procedures in adults" and "Antimicrobial prophylaxis for prevention of surgical site infection in adults", section on 'Timing'.)

Venous thromboembolism prophylaxis — Patients undergoing a colectomy are at risk for developing a deep venous thrombosis. Prophylaxis is discussed in detail separately. (See "Prevention of venous thromboembolic disease in surgical patients".)


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Literature review current through: Oct 2014. | This topic last updated: Sep 12, 2014.
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