Hemicolectomy Surgery in Delhi, India

Based on the side of the colon removed, it can be divided into two types:

• Right hemicolectomy:The ascending colon is removed, and the transverse colon is reattached to the small intestine.
• Left hemicolectomy:The descending colon is removed before reattaching the transverse colon.

Hemicolectomy is done to remove the diseased part of the colon and save the healthy part of the colon. Colectomy is commonly performed in the following conditions:

• Colon cancer
• IBS or inflammatory bowel disease, for example, Ulcerative colitis and Crohn's disease
• Trauma or injury to the abdomen
• Diverticulitis - inflammation of the diverticula of the colon
• Polyps or abnormal benign tissue growths

Some contraindications of hemicolectomy include:

• In patients with acute obstruction in a malignant condition, for which a two-stage right hemicolectomy is advisable
• Large intestinal obstructions with altered parameters and vital signs
• Coagulopathy
• Cardiopulmonary impairment

Before the surgery, doctors perform a thorough medical history to assess any pre-existing medical conditions that may interfere with the procedure. The tests recommended by doctors before a hemicolectomy procedure are:

• Colonoscopy: This is a test in which a doctor evaluates the inner lining of the large intestine using a scope inserted into the large intestine from the anus.
• Electrocardiogram - to assess the rhythm of the heart 
• Blood tests - Complete blood count and other blood tests to determine haemoglobin levels, platelet counts, presence of infection and more.
• Urine analysis
• Echocardiogram 
• CT scan or MRI

Hemicolectomy can be performed in three ways:

• Laparoscopic surgery
• Robotic surgery
• Open surgical procedure

The colon has three parts:

• Ascending colon - attached to the small intestine
• Transverse colon - between the ascending and descending colon
• Descending colon - attached to the rectum

Firstly, a doctor administers general anaesthesia to sedate the patient. During surgery, an IV drip is inserted to control pain and balance body electrolytes. Next, a nasogastric tube is pushed through the nose into the stomach. Subsequently, a catheter is inserted into the bladder to drain urine. After these procedures, the patient is ready for surgery.

Laparoscopic procedure

Small incisions are made to access the surgical site, and a thin scope is pushed within. The surgical instruments are then inserted, and the surgeon performs the surgery. This procedure is also called keyhole surgery. Open surgery is indicated if the surgeon cannot achieve success through the laparoscopic method.

Robotic procedure

The procedure is done the same way as in laparoscopy, except that the surgery is done by a robot guided by the surgeon. This improves the precision with which the surgery is performed.

Open surgery procedure

Longer cuts are made in the body to access the colon. Hence, the recovery may take longer. 

The hemicolectomy procedure takes about 3-4 hours. However, it may take longer, depending on any complications that may occur during the procedure.

During the presurgical consultation visit, the doctor conducts a complete physical examination before the surgery to assess for any medical conditions. Some medical conditions affect surgical procedures. The potential risks and benefits of the surgery are discussed. In addition, a list of presurgical restrictions and other instructions to follow is given.

Sometimes, the doctor may have to attach the colon/small intestine to the skin to allow for the elimination of waste matter from the body. This is called a stoma, and a bag is applied to the skin around the stoma. The patient is well informed about whether this procedure is likely to be required or not and also the duration for which it is likely to be required.

Doctors recommend stopping blood thinners from preventing bleeding during the surgery. These medicines should be stopped for some time before the surgery, depending on the medicine which is being taken.

Laxatives may be prescribed a few days before the surgery to empty the bowels and clear the digestive tract, a procedure called bowel prep. This step helps reduce the risk of infection. 

One has to avoid eating for at least 6-8 hours before the operation to prevent any side effects of anaesthesia. Orally clear liquids can be taken up to 3 hours before a planned surgery in discussion with the treating team. Oral liquid intake till 3 hours before surgery has been shown to significantly help patients recover better and faster.

Taking someone along for the surgery is crucial since they can provide support and assist with the postoperative instructions. It may take several hours for the effects of the anaesthesia to wear away.

Like most abdominal surgeries, Hemicolectomy also carries some risks in the form of the following complications:

• Anaesthetic complications
• Diarrhoea or constipation
• Fever
• Pus formation in the operated area
• Pain in the abdomen
• Leakage from sutures around the surgical area
• The formation of blood clots may occur in the lungs or legs
• Infections
• Damage to organs adjacent to the colon
• Scar tissue blocking the colon

Hemicolectomy is a major surgery that requires time to heal. Returning to routine activities may take some time. Feeling dizzy from anaesthesia post-surgery is normal. Pain medications administered through IV help control pain after the surgery.

The doctor follows up for the next few days to check for how much food can be eaten, assess for any signs of infection or complications from the surgery, and check for gas and solid waste passage.

Some patients may require an additional stay at the hospital of a week or two until they recover enough to return home. This is true for patients with open hemicolectomy. For controlling pain at home, doctors prescribe painkillers such as ibuprofen, paracetamol, or diclofenac sodium and medicines to manage constipation.

Avoid lifting any heavy objects for about six to eight weeks.

Nowadays, it is preferred that patients be allowed ora diet in some form after about 6 hours of surgery. This would gradually escalate depending on the patient's recovery and tolerance to the oral diet. In the long-term, usually, no significant change in the diet is needed after the procedure, but in case of diarrhoea or stomach cramps, some of the foods that may help regulate bowel movements are:

• Apple sauce
• Bananas
• Fibre-rich foods or supplements
• Cheese
• Oatmeal 
• Yoghurt
• Cream of wheat
• Mild tea
• Pasta
• Potatoes

Doctors recommend drinking excess water to balance electrolytes and prevent dehydration in the body.

What is a Hemicolectomy, and why is it performed?
A hemicolectomy is a surgical procedure involving the removal of a portion of the colon or large intestine. It is performed to treat conditions such as colorectal cancer, diverticulitis, Crohn's disease, ulcerative colitis, and large polyps that cannot be removed by other means. A hemicolectomy aims to remove the affected segment of the colon and reestablish normal bowel function.

How is a Hemicolectomy different from a colectomy?
A hemicolectomy is a specific type of colectomy that involves the removal of either the right or left portion of the colon. In a hemicolectomy, either the ascending colon and cecum (right hemicolectomy) or the descending colon (left hemicolectomy) is removed. A colectomy, on the other hand, refers to the removal of the entire colon.

What conditions or diseases typically require a Hemicolectomy?
Hemicolectomy is commonly performed for conditions such as colorectal cancer, diverticulitis, inflammatory bowel disease (Crohn's disease or ulcerative colitis), and large polyps that are at risk of becoming cancerous. The specific indication for a hemicolectomy depends on the individual patient's diagnosis and the extent of the disease.

How is a Hemicolectomy performed? What are the surgical techniques involved?
A hemicolectomy may be performed using open surgery or minimally invasive techniques like laparoscopy or robotic-assisted surgery. In open surgery, a single large incision is made across the abdomen to access the colon. In minimally invasive techniques, several small incisions are made, and a laparoscope or robotic instruments are used to visualize and perform the surgery. The affected portion of the colon is removed, and the remaining healthy ends are either sutured or stapled together, allowing for continuity of the digestive tract.

Is a Hemicolectomy performed using open surgery or minimally invasive techniques?
A hemicolectomy can be performed using both open surgery and minimally invasive techniques. Open surgery involves a larger incision, while minimally invasive techniques, like laparoscopy or robotic-assisted surgery, use smaller incisions and specialized instruments. The choice of technique depends on factors like the patient's overall health, the extent of the disease, and the surgeon's expertise.

What are some risks and complications associated with a Hemicolectomy?
Like any surgical procedure, a hemicolectomy carries certain risks and potential complications. These may include bleeding, infection, adverse reactions to anaesthesia, blood clots, injury to surrounding structures, anastomotic leaks (leaks at the reconnection site), bowel obstruction, and postoperative hernias. However, it's important to note that the overall risk of complications is low, and surgeons take measures to minimize these risks.

How long does the recovery process take after a Hemicolectomy?
The recovery process after a hemicolectomy varies from person to person, but patients can expect to stay in the hospital for a few days to a week. It may take several weeks to fully recover and resume normal activities. The surgical team will provide specific instructions for postoperative care, including pain management, dietary modifications, and gradually increasing physical activity.

What dietary changes are necessary after a Hemicolectomy?
Following a hemicolectomy, dietary changes are usually recommended to promote healing and prevent complications. Initially, a patient may be placed on a clear liquid diet and then gradually transitioned to a low-fiber, easily digestible diet. Over time, a regular diet can be resumed, but it is important to maintain a healthy and balanced intake of fibre, fluids, and nutrients to support optimal bowel function.

Can a Hemicolectomy result in changes in bowel habits or stool consistency?
Yes, a hemicolectomy can potentially result in changes in bowel habits and stool consistency. Some individuals experience temporary or permanent alterations in bowel movements, such as increased frequency, loose stools, or mild urgency. However, many patients adapt to these changes over time, and with proper dietary management, the majority can achieve a satisfactory level of bowel function.

Are there long-term effects or complications associated with a Hemicolectomy?
Long-term effects and complications after a hemicolectomy are generally rare, but they can include chronic diarrhoea, bowel obstruction, hernias, or problems related to the anastomotic site. However, these complications occur infrequently, and most patients have a good long-term outcome with restored bowel function and an improved quality of life.

Can a Hemicolectomy cure Colorectal cancer?
A hemicolectomy is a standard treatment for localized colorectal cancer and can often provide a cure, particularly in the early stages of the disease. By removing the affected portion of the colon along with nearby lymph nodes, the surgery aims to eliminate the cancer and prevent its spread. Adjuvant treatments like chemotherapy or radiation therapy may be recommended in addition to surgery, depending on the specific characteristics of the cancer.

Can a Hemicolectomy be performed as a preventive measure for individuals at high risk of Colorectal cancer?
In some cases, a hemicolectomy may be recommended as a preventive measure for those at high risk of developing colorectal cancer, like those with certain hereditary conditions (e.g., Lynch syndrome, familial adenomatous polyposis). The decision to undergo a preventive hemicolectomy is usually based on a careful evaluation of the individual's medical history, genetic testing, family history, and a thorough discussion with a doctor or genetic counsellor.

What are the alternatives to a Hemicolectomy for treating colorectal conditions?
The alternatives to a hemicolectomy for treating colorectal conditions depend on the specific diagnosis and disease severity. In some cases, less invasive procedures such as endoscopic resection or polypectomy may be sufficient. Additionally, certain conditions may respond well to medical management, such as medications for inflammatory bowel disease or diverticulitis.

Can a Hemicolectomy be performed in elderly patients or those with comorbidities?
Yes, a hemicolectomy can be performed in elderly patients or those with comorbidities, but individual assessment and careful consideration of the patient's overall health and risks are essential. The surgical team will evaluate the patient's medical history, perform necessary preoperative assessments, and determine the patient's fitness for surgery. Age or comorbidities alone do not necessarily exclude someone from undergoing a hemicolectomy, but a comprehensive evaluation is needed to ensure the best possible outcomes.

Are there any specific preoperative preparations required for a Hemicolectomy?
Before a hemicolectomy, specific preoperative preparations may be required. These preparations may include blood tests, imaging studies, bowel cleansing to empty the colon, and fasting instructions. The healthcare team will provide detailed instructions regarding medications to be taken or avoided before surgery and guide lifestyle modifications or restrictions.

How is the decision made between a partial hemicolectomy and a total colectomy?
The decision between a partial hemicolectomy and a total colectomy depends on the individual patient's diagnosis, the location and extent of the disease, and the goals of the surgery. In cases where the disease is limited to a specific segment of the colon, a partial hemicolectomy may be sufficient to remove the affected area while preserving the remaining healthy colon. However, if the disease is extensive or involves multiple segments of the colon, a total colectomy may be necessary to ensure complete removal of the diseased tissue. The decision is made based on careful evaluation and discussion between the patient and the healthcare team.

Can a Hemicolectomy lead to complications such as bowel obstruction or leakage?
While rare, complications such as bowel obstruction or leakage can occur following a hemicolectomy. Bowel obstruction may result from scar tissue formation or narrowing of the remaining colon, requiring additional treatment or surgery. Anastomotic leakage, characterized by the leakage of fluid or stool from the reconnection site, is a potential but uncommon complication. Surgeons take precautions during the surgery to minimize these risks, and appropriate postoperative care and monitoring are provided to detect and address any complications.

What are the potential long-term outcomes and survival rates after a Hemicolectomy?
The long-term outcomes and survival rates after a hemicolectomy depends on several factors, including the underlying condition being treated (e.g., colorectal cancer), the stage of the disease, and the patient's overall health. For early-stage colorectal cancer, the five-year survival rate can be quite high, especially when the surgery is followed by adjuvant treatments if necessary. The healthcare team will provide specific information and discuss the expected outcomes based on the individual's situation.

Can a Hemicolectomy result in fertility issues for women?
In some cases, a hemicolectomy may impact fertility in women, particularly if the surgery involves the removal of reproductive structures or if adhesions form in the pelvis. However, the impact on fertility is highly individual. It depends on factors such as the extent of the surgery, the presence of any underlying reproductive conditions, and the woman's overall fertility status. Discussing fertility concerns with a doctor can provide personalized guidance based on the situation is necessary.

Is Chemotherapy or Radiation therapy typically recommended after a Hemicolectomy?
The decision to recommend chemotherapy or radiation therapy after a hemicolectomy depends on several factors, including the stage of the disease, the presence of any high-risk features, and the specific type of cancer being treated. Adjuvant chemotherapy is commonly recommended for certain stages of colorectal cancer to target any remaining cancer cells and reduce the risk of recurrence. Radiation therapy may be considered in specific cases, such as rectal cancer. The oncology team decides to proceed with adjuvant treatments based on the individual's circumstances.

What is the role of laparoscopic or robotic-assisted techniques in Hemicolectomy?
Laparoscopic or robotic-assisted techniques have become increasingly utilized in hemicolectomy procedures. These minimally invasive approaches offer potential benefits such as smaller incisions, reduced postoperative pain, shorter hospital stays, and quicker recovery than traditional open surgery. The technique chosen depends on factors like the patient's condition, the surgeon's expertise, and the availability of appropriate resources. However, not all patients are suitable candidates for these techniques, and the decision is made on a case-by-case basis.

Can a Hemicolectomy lead to changes in body weight or nutritional deficiencies?
Following a hemicolectomy, some individuals may experience temporary body weight or nutritional status changes. The extent of the surgery and the portion of the colon removed can affect the absorption of nutrients and water. In the short term, some weight loss may occur due to decreased food intake or surgical stress. However, with proper dietary guidance and monitoring, most patients can maintain a healthy weight and prevent nutritional deficiencies.

How often should follow-up appointments and surveillance be scheduled after a Hemicolectomy?
The frequency of follow-up appointments and surveillance after a hemicolectomy depends on factors such as the underlying condition, the stage of the disease, and the individual's overall health. Generally, regular follow-up appointments are recommended to monitor recovery, assess potential complications, and provide ongoing support and guidance. The healthcare team will provide specific recommendations regarding the timing and frequency of follow-ups and any necessary surveillance tests or imaging studies.

Can a Hemicolectomy be performed in combination with other surgical procedures?
Yes, a hemicolectomy can be combined with other surgical procedures when necessary. For example, in cases where there is a need to remove nearby organs or structures affected by the disease, additional procedures such as liver resection, lymph node dissection, or pelvic exenteration may be performed simultaneously or in a staged manner.

What are the indications for emergency Hemicolectomy?
Emergency hemicolectomy may be required in certain situations where there is a life-threatening condition or complication, such as a perforated colon, severe gastrointestinal bleeding, or a complete obstruction of the colon. Surgery is performed urgently in these cases to address the critical condition and stabilize the patient. Emergency hemicolectomy is typically performed to remove the diseased portion of the colon and prevent further complications.

Review

Reviewed by Dr. Nikhil Agrawal, Director - Cancer Care / Oncology, Surgical Oncology, Gastrointestinal & Hepatobiliary Oncology, Gastro Intestinal & Hepatopancreatobiliary Surgical Oncology, Robotic Surgery.