RIGHT HEMICOLECTOMY

Operative Technique:

Patient supine under General Anesthesia

Asepsis and antisepsis technique

Sterile drapes placed

Midline incision made

Findings noted

Umbilical tape ligature applied proximal and distal to the tumor

Right paracolic peritoneum divided using either metzenbaum and electrocautery

Ureter identified

Ascending and transverse colon mobilized

Ileal mesentery divided

Ileocolic vessels identified, isolated, doubly ligated and divided

Intestinal/Allen clamps placed 10cm of terminal ileum

Middle colic vessels identified

For cecal masses – left branch of middle colic artery preserved and the right branch divided and ligated just beyond the bifurcation

For masses near hepatic flexure – middle colic vessels dissected and divided

Intestinal/Allen clamps applied

Cecal mass – mid-transverse colon

Mass near hepatic flexure – distal transverse colon

Wound protector drape placed into the abdominal incision

Division of ileum and colon, Intestinal clamps reapplied leaving 10 cm margin fro anastomosis

Viability of ileum and colon end for anastomosis evaluated

Two layer end-to-end anastomosis done

Chromic 3-0 continuous suture using Connell

Silk 4-0 interrupted Lembert sutures to invert first layer

Peritoneal lavage

Hemostasis

Complete sponge and instrument count

Peritoneum and Fascia closed using continuous vicryl 0 suture with interrupted external bolsters

Skin closed partially

Dry sterile dressing applied