Perioperative management - Right hemicolectomy, laparoscopically assisted

• Adenocarcinoma of the cecum or ascending colon
• Carcinoid of the appendix, if appendectomy is inadequate oncologically

• 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)

• 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.

• Usually not required, but
• in suspected tumor invasion of the ureter or its involvement in peritumoral inflammation the right ureter should be stented!

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