What is a hemicolectomy?
In a hemicolectomy, part of the colon is surgically removed. However, the remaining part continues to contribute to digestion. This is the main difference to a colectomy, i.e. the removal of the entire colon from the small intestine onwards. Depending on which part is removed, doctors refer to it as a “right hemicolectomy” or a “left hemicolectomy”.
The structure of the large intestine
The large intestine has the task of removing water from the chyme that comes from the small intestine (ileum). On the way to the rectum, it also adds mucus to the feces so that they can glide better. At the same time, the large intestine is populated by countless bacteria that help to digest fiber and train the immune system. To fulfill these functions, the human colon consists of the following sections:
- Large intestine (colon):
- Appendix (coecum): Located at the interface between the small and large intestine
- ascending part (ascending colon): leads from the right lower abdomen into the upper abdomen
- Transverse colon: runs from the right upper abdomen to the left upper abdomen
- Descending part (descending colon): leads from the left upper abdomen to the right lower abdomen
- Sigmoid colon (sigmoid colon): this S-shaped section connects the large intestine with the rectum
When is a hemicolectomy performed?
Doctors generally try to remove as little bowel as possible. However, if this is not possible due to the extent of a disease, a hemicolectomy or even a complete colectomy is required.
A common reason for surgery is cancer of the colon, for example colorectal carcinoma. The rule here is: remove as much as necessary, as little as possible. However, it is important to maintain a large safety margin in order to completely remove the cancerous focus. This can often only be achieved with a hemicolectomy.
In addition to colon cancer, a hemicolectomy may also be necessary due to other forms of cancer. Namely, if metastases have formed in the colon. This happens, for example, with ovarian cancer or tumors in the kidney area.
Another reason for a hemicolectomy is chronic inflammatory bowel disease such as Crohn’s disease or ulcerative colitis. In these cases, parts of the colon are chronically inflamed, which can lead to symptoms such as bleeding and diarrhea and even fecal incontinence. If drug therapies have been exhausted, it is sometimes necessary to remove the affected parts of the bowel.
What is done during a hemicolectomy?
During a hemicolectomy, the patient is operated on under general anesthesia. This means that the patient is not aware of the operation and does not experience any pain. Before the surgeon begins the actual procedure, the patient is given an intravenous antibiotic. This is to prevent inflammation, which can occur due to the high bacterial density in the bowel during bowel surgery. After the skin has been completely disinfected, the surgeon opens the abdominal cavity with a large incision in the middle of the abdomen. The intestinal tissue is then removed, including the blood and lymph supply to the relevant section of the intestine. There are two basic types of hemicolectomy:
- Right-sided hemicolectomy: The area between the end of the small intestine and the transverse colon is removed.
- Left-sided hemicolectomy: The section of bowel between the transverse colon and the sigmoid colon is removed.
The surgeon then checks that the suture is tight and that there is no major secondary bleeding. This can be determined, for example, with a colonoscopy, which is performed during the operation. Before the abdomen is closed, the doctor usually inserts so-called drains. These are tubes that collect and drain the wound fluid. This helps the wound to heal quickly after a hemicolectomy.
What are the risks of a hemicolectomy?
Like any operation, a hemicolectomy also involves risks. Despite the great care taken during disinfection, infections can occur in the area of the sutures if naturally occurring bacteria from the intestine enter the wound. In the worst case, this can lead to inflammation of the peritoneum and blood poisoning. However, this is prevented in most cases by the preventive administration of antibiotics.
The wound area can also bleed heavily during or after the hemicolectomy. In the former case, blood reserves are used during the operation, but in the case of post-operative bleeding, another operation must be performed quickly to stop the bleeding.
As a hemicolectomy is a major procedure, other organs such as the small intestine or nerves can also be injured during the operation.
What do I need to consider after a hemicolectomy?
Even if you are still very weak after such an extensive operation, you should stay in bed for as short a time as possible in order to mobilize your body more quickly. In the weeks following the operation, however, it is better to refrain from lifting heavy loads so as not to damage the skin suture on the abdomen.
During your stay in hospital, nursing staff will help you with difficult activities, such as personal hygiene or dressing. It is also very important that you pay attention to warning signs such as pain, fever, weakness or a hard abdominal wall, as these symptoms may indicate impending complications. In this case, urgently inform a doctor, preferably your surgeon who performed the procedure.
Dietary structure and digestion
Provided there were no complications during the hemicolectomy, you can start eating again a few hours after the operation under medical supervision. Initially, your diet will consist only of liquids such as tea and broth, but you will often have a small breakfast the next morning. This has the advantage that your gastrointestinal tract quickly becomes active again and can adapt more easily.
