Perioperative management - Right hemicolectomy, laparoscopically assisted - general and visceral surgery
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Indications
- Adenocarcinoma of the cecum or ascending colon
- Carcinoid of the appendix, if appendectomy is inadequate oncologically
Contraindications
- Adenocarcinoma of the hepatic flexure
- Familial adenomatous polyposis (restorative proctocolectomy with iileal pouch-anal anastomosis)
- Cancer arising from ulcerative colitis (proctocolectomy with ileal pouch-anal anastomosis)
Preoperative diagnostic work-up
- Complete colonoscopy with biopsies for histopathologic confirmation, if possible with ink marking for easy intraoperative identification.
- Lab panel: RBC, CRP, coagulation, creatinine, electrolytes, blood group, antibody screening, CEA
- Abdominal ultrasonography, chest film (2 views), possibly MRI of liver, contrast-enhanced ultrasound liver study and/or thoracic/abdominal CT.
Special preparation
- Usually not required, but
- in suspected tumor invasion of the ureter or its involvement in peritumoral inflammation the right ureter should be stented!
Informed consent
General risks
- Bleeding
- Secondary bleeding
- Thrombosis
- Embolism
- Wound infection
Special risks
- Injury to the right ureter
- Injury to the duodenum
- Secondary anastomotic failure
- Incisional and trocar hernia
Anastomotic stricture
Anesthesia
Positioning
Operating room setup
Special instruments and fixation systems
Postoperative management
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