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

INDICATIONS

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.

PREOPERATIVE PREPARATION

Mechanical bowel preparation — Preoperative mechanical bowel preparation (MBP) is unnecessary for patients undergoing elective open right-sided colon surgery, based upon the review of 14 randomized trials and 8 meta-analyses by the Canadian Society of Colon and Rectal Surgeons [1]. (See "Surgical oncologic principles for the resection of colon cancer", section on 'Bowel preparation'.)

Prophylactic antibiotics — The use of antibiotic pro[phylaxis is reviewed elsewhere (table 1 and table 2). We do not use oral antibiotics or continue prophylaxis postoperatively. The efficacy of adding oral antibiotics to decrease the surgical wound infection rate has not been established in uncleansed bowel.

The use and timing of antimicrobial prophylaxis for prevention of surgical site infection following gastrointestinal procedures is discussed separately. (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'.)

                               

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Literature review current through: Mar 2014. | This topic last updated: Feb 27, 2014.
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References
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