Crohn's / IBD

What is a hemicolectomy? Uses and procedure

A hemicolectomy is a surgical procedure that involves removing a segment of the colon. It is typically performed to treat colon cancer or a bowel disease, such as Crohn’s disease or severe diverticulitis.

During this surgery, the damaged section of the colon is removed and the healthy parts of the colon are reattached.





Why is a hemicolectomy performed?


The colon
The colon is also known as the large intestine.


The colon, which is also called the large intestine, sits inside the abdominal cavity.


It starts at an area of the abdominal cavity called the iliac region and continues up the abdomen and across the width of the abdominal cavity. The colon then travels down the left side and ends at the anus.


One of the primary functions of the colon is to regulate water in the body. The colon absorbs water from the foods a person eats. It also absorbs certain vitamins and processes waste.


However, the colon can become damaged from trauma or disease, including cancer.


If colon cancer develops, surgery is often recommended to remove the tumor or part of the large intestine.


In instances of bowel disease, surgery may be needed to remove the diseased or damaged section of the large intestine.


During a hemicolectomy, only one side of the colon is removed. The side of the colon removed depends on the location of the tumor or diseased intestine.


Part of the colon can be removed without affecting a person’s ability to digest food.




How is a hemicolectomy performed?


A hemicolectomy can be performed either laparoscopically or using open surgery.


When surgery is done laparoscopically, a surgeon makes small incisions in the abdominal wall and inserts a thin scope. The scope has a lens and light for viewing purposes.


The doctor will also insert surgical instruments through the small cuts in the abdomen.


If the procedure cannot be performed laparoscopically, open surgery will be required.


An open hemicolectomy involves making longer cuts to access the colon. Since the cuts are larger with an open procedure, recovery may be longer.


The colon is composed of three parts: the ascending colon, which attaches to the small intestine, the descending colon, which attaches to the rectum, and the transverse colon, which is located between the ascending and descending colon.


A hemicolectomy may involve removing a portion of the colon on the right or left side, depending on the location of the cancer or diseased bowel.


If a right hemicolectomy is done, the ascending colon is removed. The transverse colon is then attached to the small intestine.


During a left hemicolectomy, the descending colon, the section of the colon attached to the rectum, is removed. The transverse colon is then attached to the rectum.



How to prepare


blood being taken for testing
A doctor may take a number of tests prior to a hemicolectomy, including blood tests.


Preparation for a hemicolectomy will vary, depending a person’s overall health and the medications they take.


Typically, a doctor will perform preoperative tests to make sure a person is an appropriate candidate for a hemicolectomy. These include an electrocardiogram (EKG) and blood tests.


A person may be asked to stop taking certain medications, such as blood thinners, for a specific amount of time before the surgery. However, it is essential only to stop medications when instructed by a doctor.


People will need to fast for 12 hours before their procedure. Bowel prep, which involves taking a laxative to clean out the colon, may also be required.




Risks and complications


A hemicolectomy can be an effective treatment for diseases such as colon cancer. But as with any surgery, there are risks involved.


While it may not be possible to prevent all complications, following the doctor’s recommendations after the procedure may decrease the risks.


Here are some possible complications of a hemicolectomy:


Excessive bleeding


If a person has an open hemicolectomy instead of laparoscopic surgery, there is a higher chance of excessive bleeding


In some cases, a transfusion may be needed to treat blood loss.


Internal injury


During the procedure, damage to the bladder or surrounding organs can occur. Depending on the extent of the damage, additional surgery may be required or recovery may be delayed.




Anastomotic leak


When the diseased section of the colon is removed, the healthy segments are sewn together. The site where the colon is reattached is called an anastomosis.


After a hemicolectomy, the bowel can leak at the anastomosis. Symptoms of a leak may include nausea, vomiting, and stomach pain.


An anastomotic leak can be life-threatening. According to the National Institute of Health, an anastomotic leak can have a fatality rate of up to 39 percent.


Infection


Infections can develop with any intestinal surgery, including a hemicolectomy. An infection will usually need to be treated with antibiotics, and may require a longer hospital stay.


Colostomy


Another risk of a hemicolectomy is that the surgeon will not be able to reattach the remaining colon to another part of the intestine or the rectum.


In some cases, a colostomy may need to be performed. A colostomy involves attaching the colon to the abdominal wall, and creating an opening called a stoma.


A colostomy bag is attached to the stoma to collect the waste. A colostomy may be permanent or only temporary.



Recovery


in a hospital bed
A hemicolectomy may typical require a hospital stay of between 3-7 days.


Recovery from a hemicolectomy depends on whether the procedure is performed laparoscopically or using open surgery.


A person’s underlying health condition may also affect recovery. In many instances, a hemicolectomy without complications requires a hospital stay of 3-7 days.


Typically, a bladder catheter to drain urine from the body will remain for a day or two after the procedure. Abdominal drains may also be placed to remove fluids.


Pain medication is usually given through an epidural, which is inserted into the back near the spine. Once the epidural is removed, further medication may be given orally.


Although it can vary, people are often allowed to eat and drink as soon as they feel ready.


The doctor may encourage a person to start walking as soon as possible after the procedure. Walking decreases the chances of a blood clot developing and also promotes proper digestion.


Once a person is discharged from the hospital, they are given specific recovery instructions. These include when they can resume everyday activities, such as driving and lifting heavy objects.




Outlook


The outlook for people who have a hemicolectomy varies based on the reason they need the procedure.


Some people may need to make lifestyle or dietary changes following the procedure.


People who undergo a hemicolectomy to treat a bowel disease may feel better and have reduced symptoms after the surgery.


If the surgery was performed to treat colon cancer, the outlook will depend on the extent of the cancer. Additional treatment, such as chemotherapy, may also be recommended.

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