Open Right Colectomy (Right Hemicolectomy) Periprocedural Care

Updated: Oct 02, 2015
  • Author: Ashwin Pai, MBBS, MS (GenSurg), MRCS; Chief Editor: Kurt E Roberts, MD  more...
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Periprocedural Care

Preprocedural Planning

Thorough preparation of the bowel is necessary before the operation. Standard bowel preparation may be conducted over a 24-hour period and is usually performed after admission. The patient is allowed to drink only clear liquids for 24 hours, and about 4 L of polyethylene glycol solution is given to the patient to be taken over 2-3 hours in the afternoon of the day before the procedure. A sodium phosphate enema is given on the night before the operation. [1]

Two doses of metronidazole and neomycin sulfate are given after the lavage preparation on the day before surgery. An intravenous (IV) second-generation cephalosporin is administered within 1 hour before incision. Electrolyte levels are obtained again on the night before surgery after the lavage.

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Equipment

Open right hemicolectomy is performed with a standard laparotomy set, as follows:

  • Scalpel with No. 11 and No. 15 blades
  • Curved and straight artery forceps
  • A pair of toothed thumb forceps
  • A pair of nontoothed forceps
  • Allis forceps
  • Noncrushing intestinal clamps
  • Surgical cautery
  • Hemostatic clips or ligatures
  • Handheld ultrasonic dissector (if available)
  • Abdominal wall retractors/self-retaining retractors
  • Atraumatic visceral retractors
  • Suture material (absorbable and nonabsorbable)
  • Anastomotic staplers
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Patient Preparation

Anesthesia

General anesthesia is preferred for an open right hemicolectomy. An additional epidural block can be placed for postoperative pain management. After induction of anesthesia, a 16-French or 18-French Ryle tube is passed and kept on continuous drainage. The patient is then catheterized with a 14-French Foley catheter for monitoring of intraoperative and postoperative urine output. [3]

Positioning

The standard position for an open right hemicolectomy is supine with strapping of the ankle and wrists to allow intraoperative changes to other positions, such as the Trendelenburg position. The surgeon stands on the patient's left, and the first assistant stands across from the surgeon on the patient's right. The scrub nurse stands beside the surgeon. If a second assistant is needed, he or she usually stands across from the surgeon to the left of the first assistant.

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Monitoring and Follow-up

Postoperatively, nasogastric aspiration is maintained until ileus resolves. Clear liquids are started when the patient has a soft abdomen with normal bowel sounds and expels flatus without nausea, vomiting, or abdominal distention. If the patient tolerates liquids well, normal intake can be started after 2 days. IV fluids should be continued until the patient can tolerate normal oral intake. The urinary catheter may be removed 2-3 days after the operation.

Patients who recover sufficiently may be discharged on day 8, and sutures or staples may be removed on day 10. [1]

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