What is open left hemicolectomy?
The colon or the large bowel is a part of the large intestine. The colon is typically divided into:
- The left half of the transverse colon (the middle straight part of the colon)
- The descending colon that connects to the sigmoid colon
- The sigmoid colon which connects to the rectum
Left hemicolectomy (left colectomy) is the surgical removal of the left side of the colon along with the fat and the surrounding lymph nodes. This surgery is mostly performed for cancers of the left colon.
Other conditions where left hemicolectomy is performed include:
- Perforation (hole) of the colon due to trauma (e.g., gunshot injury to the abdomen)
- Chronic diverticular disease (small bulges in the colon)
- Sigmoid volvulus (twisting of the sigmoid colon)
- Ischemic colitis (the death of the intestinal cells because of reduced blood supply)
- Lower intestinal bleeding due to various causes
- Precancerous conditions of the colon
The left hemicolectomy surgery can be performed via the open or the laparoscopic approach:
- Laparotomy (open surgery): A large incision is made into the abdomen to perform the surgery.
- Laparoscopic surgery: Four to five small incisions are made into the abdomen, and a long camera (laparoscope) is inserted in one of the incisions to visualize the internal structures and perform the surgery.
What makes you unfit for open left hemicolectomy?
A surgeon will recommend you against open left hemicolectomy if you
- Have severe medical comorbidities making you unfit for the surgery.
- Are critically ill.
What is done before left hemicolectomy?
- Your surgeon will take your complete history and examine you physically.
- They will ask you to undergo computed tomography (CT) of the abdomen and pelvis and X-ray of the chest.
- You may be asked to undergo a test known as full colonoscopy where a long tube-like camera will be inserted in your anus to visualize your colon.
- You will be counseled about the risks and complications of the surgery.
- You will be given enema either on the previous night before the surgery or on the morning of the surgery.
- You will be advised to have only a clear-liquid diet the day before and nothing at all for 12 hours before your operation.
- Only the essential medications are allowed, with a sip of water, on the morning of the operation.
- Your doctor will put you on antibiotics and fluids via intravenous route (IV) on the day of operation.
- A tube-like structure known as Foley catheter will be inserted into your bladder through your urethra to collect urine.
How long does a left hemicolectomy take?
- A left hemicolectomy usually takes about two to four hours, but it may take longer depending on any complications during the procedure.
- For open left hemicolectomy, an incision of about six inches is made on the left side of your abdomen.
- The surgeon will retrieve your left colon and cut (resect) it.
- The open end of the remaining colon will be connected to the rectum (end-to-end anastomosis), or it will be opened through an incision on the skin (colostomy) which is connected to a colostomy bag for emptying of stool.
- The surgeon then staples or sutures and bandages the surgical wound.
What happens after the open left hemicolectomy procedure?
- You are not allowed to eat for 24 hours after the surgery.
- Intravenous (IV) fluids and antibiotics are continued for up to 24 hours.
- After 24 hours, you are allowed to have clear liquids as tolerated.
- The Foley catheter is removed on the next day of the procedure.
- You will be encouraged to walk and move around after two days.
- You will be given a soft diet (foods that are easy to chew and swallow) as soon as you pass gas and stools.
- Depending upon how well you tolerate the soft diet and how fast your bowel function returns to normal, you will be discharged after three to seven days of your surgery.
- Follow-up is usually scheduled 10-14 days after discharge.
Is a hemicolectomy major surgery?
A hemicolectomy is a major surgery. You may not be able to get back to normal activities for four to six weeks or even more afterward if you suffer from any of its complications.
The possible complications of open left hemicolectomy include:
- Excessive bleeding
- Wound infection
- Urinary tract infection
- Deep vein thrombosis (blood clot in the leg)
- Pulmonary embolism (blood clot in the lung)
- Wound dehiscence (reopening of the surgical wounds)
- Leaking from the colon
- Paralytic ileus (loss of muscle functioning of the colon)
- Tumor recurrence
- Bowel obstruction
- Sexual or urinary problems
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