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Anatomy - Left hemicolectomy, open, curative

general and visceral surgery
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Anatomy Perioperative management Technique Complications Evidence Total Video

  1. Overview

    Overview
    • The colon surrounds the loops of the small intestine along the inner abdominal wall and below the liver and stomach. The position of the colon is intra- or secondarily retroperitoneal. Its primary function is the thickening of the chyme through the absorption of water. The total length of the colon is on average 120-150 cm. The colon begins at the ileocecal valve and ends at the rectosigmoid junction, where it transitions into the rectum.
    • The colon is divided into the following sections:
      • Cecum with the appendix
      • Ascending colon
      • Transverse colon
      • Descending colon
      • Sigmoid colon

  2. Macroscopy

    Macroscopy
    • The longitudinal muscle layers of the colon form three band-like muscle strips that are visible from the outside and are referred to as taeniae. They are distinguished as follows:
      • Taenia mesocolica: located towards the mesentery
      • Taenia libera: free on the surface, facing the abdominal wall
      • Taenia omentalis: connected with the greater omentum
    • Appendices epiploicae are fat appendages from the tela subserosa in the area of the free taeniae.
    • Plicae semilunares are indentations of all wall layers intraluminally, whereas haustra are the outward bulges in between.
    • For left hemicolectomy, the following intestinal segments are relevant from oral to aboral:
      • distal transverse colon
      • left flexure
      • descending colon
      • sigmoid colon
      • upper rectum

  3. Transverse colon, descending colon, and sigmoid colon

    Transverse colon, descending colon, and sigmoid colon
    • Transverse colon
      • Synonyms: transverse colon or simply Transversum.
      • Location: intraperitoneal; mobile fixation through its own mesentery – transverse mesocolon, runs transversely ascending through the abdominal cavity from the right to the left flexure
      • Length: 30-45 cm
      • Identification: by the three taeniae and the greater omentum attached to the taenia omentalis
      • The left flexure is always higher than the right flexure due to its fixation by the phrenocolic ligament
    • Descending colon:
      • Location: secondarily retroperitoneal
      • Peritoneal suspension: fused with the posterior wall of the abdominal cavity
      • Course: from the left flexure (here: phrenocolic ligament with fixation to the spleen) to the iliac fossa, connects to the transverse colon and transitions into the sigmoid colon
      • Length: 20-30 cm
    • Sigmoid colon
      • Location: intraperitoneal
      • Peritoneal suspension: sigmoid mesocolon
      • Course: from the iliac fossa as a loop (S-shaped) to the level of the 2nd-3rd sacral vertebrae, connects to the descending colon and transitions into the rectum
      • Length: variable (elongated sigmoid), generally: about 35 cm
Vascular supply, lymphatic drainage, and nerves

Arterial supply of the left hemicolon, sigmoid colon up to the upper rectum by the inferior mesente

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