Open Left Colectomy (Left Hemicolectomy) Periprocedural Care

Updated: Mar 21, 2016
  • Author: Juan L Poggio, MD, MS, FACS, FASCRS; Chief Editor: Vikram Kate, MBBS, MS, PhD, FACS, FACG, FRCS, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS  more...
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Periprocedural Care

Preprocedural Planning

A thorough history and physical examination are essential. Special emphasis should be placed on cardiopulmonary status so as to optimize the patient;s condition for tolerating surgical stress. A complete preoperative workup should be performed in order to establish the stage of the cancer. This includes, at a minimum, computed tomography (CT) of the abdomen and pelvis and radiography of the chest. A carcinoembryonic antigen (CEA) level is ordered for colon cancer at the time of diagnosis.

If the colonic lesion was diagnosed via flexible sigmoidoscopy, a full colonoscopy is essential to evaluate for synchronous lesions, and all lesions should be tattooed so that they can be identified at the time of surgery. Patient counseling about the risks and complications of the surgery, including the possibility of creating an ostomy, should be performed.

Mechanical bowel preparation is started the day before the operation to clear the bowel of fecal material, which would otherwise make it difficult to manipulate the colon during surgery. Some surgeons also prefer the patient to have an enema on the morning of the surgery. A clear-liquid diet is allowed the day before the procedure. All oral intake is stopped the night before the operation, and only the essential medications are allowed, with a sip of water, on the morning of the procedure.

Preoperative antibiotics to cover gram-negative and anaerobic organisms (eg, piperacillin-tazobactam or ertapenem or a combination of a second-generation cephalosporin and metronidazole) are given within 1 hour of the incision time. Many surgeons also start alvimopan, a drug that helps prevent postoperative ileus, and continue it until the patient's bowel function has returned or for up to 7 days postoperatively. Deep vein thrombosis prophylaxis is also started on the day of surgery.

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Patient Preparation

The patient is placed in a lithotomy Trendelenburg (modified Lloyd-Davis) position with both arms abducted on arm boards. The legs are placed on stirrups, with adequate soft padding to prevent pressure sores on the skin and pressure-related nerve injury to the common peroneal nerves. Antiembolic stockings or compression devices are applied to the legs.

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