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Right and extended right colectomy: Open technique

Topic Outline

GRAPHICS

INTRODUCTION

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".)

COLON ANATOMY

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'.)

Venous and lymphatic drainage — The venous drainage of the right colon is through the superior mesenteric vein (figure 3). The lymphatics drain via the corresponding arterial supply (figure 4).

                    

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