Perioperative management - Hemicolectomy left, open, curative

• Cancer of the descending colon
• Obstructions of other origin, e.g., Crohn disease

• None absolute and
• None relative

• Colon cancer: Here the usual preoperative staging, at minimum with: histologpathology; complete colonoscopy; tumor markers; ultrasonography of the liver; and chest film. A CT study of the abdomen and pelvis, and depending on the case also of the lungs, is standard practice in most departments today.
• Crohn disease: Here, complete colonoscopy is recommended. If the obstruction cannot be passed, MRI enteroclysis would be useful to determine whether the colon upstream of the obstruction still demonstrates signs of inflammation, in order to rule out possible stenotic Crohn affection in the small intestine.

In present surgery of the colon orthograde bowel lavage is no longer common practice. There are quite a number of randomized controlled trials demonstrating that patients do not benefit from this measure. Therefore, most departments only rely on preoperative enemas and possibly mild laxatives.
While in some departments complete lavage of the colon is still practiced, the present evidence argues against this measure. See also

The most important aspects

• Anastomotic failure
• Septic complications, e.g., intraabdominal abscess and wound infection
• Injury to the spleen and pancreas
• Injury to the left ureter

Further standard aspects of informed consent include

• Thrombosis and embolism
• Need for blood transfusions
• Secondary bleeding

Incisional hernia