Hemicolectomy

Based on the side of the colon removed, it can be divided into two types:

• Right hemicolectomy:The ascending colon is removed, and the transverse colon is reattached to the small intestine.
• Left hemicolectomy:The descending colon is removed before reattaching the transverse colon.

Hemicolectomy is done to remove the diseased part of the colon and save the healthy part of the colon. Colectomy is commonly performed in the following conditions:

• Colon cancer
• IBS or inflammatory bowel disease, for example, Ulcerative colitis and Crohn's disease
• Trauma or injury to the abdomen
• Diverticulitis - inflammation of the diverticula of the colon
• Polyps or abnormal benign tissue growths

Some contraindications of hemicolectomy include:

• In patients with acute obstruction in a malignant condition, for which a two-stage right hemicolectomy is advisable
• Large intestinal obstructions with altered parameters and vital signs
• Coagulopathy
• Cardiopulmonary impairment

Before the surgery, doctors perform a thorough medical history to assess any pre-existing medical conditions that may interfere with the procedure. The tests recommended by doctors before a hemicolectomy procedure are:

• Colonoscopy: This is a test in which a doctor evaluates the inner lining of the large intestine using a scope inserted into the large intestine from the anus.
• Electrocardiogram - to assess the rhythm of the heart 
• Blood tests - Complete blood count and other blood tests to determine haemoglobin levels, platelet counts, presence of infection and more.
• Urine analysis
• Echocardiogram 
• CT scan or MRI

Hemicolectomy can be performed in three ways:

• Laparoscopic surgery
• Robotic surgery
• Open surgical procedure

The colon has three parts:

• Ascending colon - attached to the small intestine
• Transverse colon - between the ascending and descending colon
• Descending colon - attached to the rectum

Firstly, a doctor administers general anaesthesia to sedate the patient. During surgery, an IV drip is inserted to control pain and balance body electrolytes. Next, a nasogastric tube is pushed through the nose into the stomach. Subsequently, a catheter is inserted into the bladder to drain urine. After these procedures, the patient is ready for surgery.

Laparoscopic procedure

Small incisions are made to access the surgical site, and a thin scope is pushed within. The surgical instruments are then inserted, and the surgeon performs the surgery. This procedure is also called keyhole surgery. Open surgery is indicated if the surgeon cannot achieve success through the laparoscopic method.

Robotic procedure

The procedure is done the same way as in laparoscopy, except that the surgery is done by a robot guided by the surgeon. This improves the precision with which the surgery is performed.

Open surgery procedure

Longer cuts are made in the body to access the colon. Hence, the recovery may take longer. 

The hemicolectomy procedure takes about 3-4 hours. However, it may take longer, depending on any complications that may occur during the procedure.

During the presurgical consultation visit, the doctor conducts a complete physical examination before the surgery to assess for any medical conditions. Some medical conditions affect surgical procedures. The potential risks and benefits of the surgery are discussed. In addition, a list of presurgical restrictions and other instructions to follow is given.

Sometimes, the doctor may have to attach the colon/small intestine to the skin to allow for the elimination of waste matter from the body. This is called a stoma, and a bag is applied to the skin around the stoma. The patient is well informed about whether this procedure is likely to be required or not and also the duration for which it is likely to be required.

Doctors recommend stopping blood thinners from preventing bleeding during the surgery. These medicines should be stopped for some time before the surgery, depending on the medicine which is being taken.

Laxatives may be prescribed a few days before the surgery to empty the bowels and clear the digestive tract, a procedure called bowel prep. This step helps reduce the risk of infection. 

One has to avoid eating for at least 6-8 hours before the operation to prevent any side effects of anaesthesia. Orally clear liquids can be taken up to 3 hours before a planned surgery in discussion with the treating team. Oral liquid intake till 3 hours before surgery has been shown to significantly help patients recover better and faster.

Taking someone along for the surgery is crucial since they can provide support and assist with the postoperative instructions. It may take several hours for the effects of the anaesthesia to wear away.

Like most abdominal surgeries, Hemicolectomy also carries some risks in the form of the following complications:

• Anaesthetic complications
• Diarrhoea or constipation
• Fever
• Pus formation in the operated area
• Pain in the abdomen
• Leakage from sutures around the surgical area
• The formation of blood clots may occur in the lungs or legs
• Infections
• Damage to organs adjacent to the colon
• Scar tissue blocking the colon

Hemicolectomy is a major surgery that requires time to heal. Returning to routine activities may take some time. Feeling dizzy from anaesthesia post-surgery is normal. Pain medications administered through IV help control pain after the surgery.

The doctor follows up for the next few days to check for how much food can be eaten, assess for any signs of infection or complications from the surgery, and check for gas and solid waste passage.

Some patients may require an additional stay at the hospital of a week or two until they recover enough to return home. This is true for patients with open hemicolectomy. For controlling pain at home, doctors prescribe painkillers such as ibuprofen, paracetamol, or diclofenac sodium and medicines to manage constipation.

Avoid lifting any heavy objects for about six to eight weeks.

Nowadays, it is preferred that patients be allowed ora diet in some form after about 6 hours of surgery. This would gradually escalate depending on the patient's recovery and tolerance to the oral diet. In the long-term, usually, no significant change in the diet is needed after the procedure, but in case of diarrhoea or stomach cramps, some of the foods that may help regulate bowel movements are:

• Apple sauce
• Bananas
• Fibre-rich foods or supplements
• Cheese
• Oatmeal 
• Yoghurt
• Cream of wheat
• Mild tea
• Pasta
• Potatoes

Doctors recommend drinking excess water to balance electrolytes and prevent dehydration in the body.