Perioperative management - Right hemicolectomy, laparoscopically assisted

  1. Indications

    • Adenocarcinoma of the cecum or ascending colon
    • Carcinoid of the appendix, if appendectomy is inadequate oncologically
  2. 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)
  3. 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.
  4. 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!
  5. 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


General anesthesia and - if possiblethoracic epidural catheterNormothermia (keep patient warm) ...

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