Hemicolectomy- Left

Cancer in the sigmoid colon and left colon are treated with left hemicolectomy procedure. Malignant tumours of the left colon or sigmoid colon are eliminated by a sigmoid resection. The surgical procedure involves the resection of the distal descending colon and the surrounding diseased tissues.

The indications of left hemicolectomy include:

• Complicated and risky premalignant polyps in the left colon
• Left side colon cancer without a secondary malignant growth (metastasis)
• Left-side colon cancer with metastasis growth with obstruction or bleeding
• Carcinoid (a type of tumour rising in the gland of the intestine) of the left colon
• Lower gastrointestinal bleeding
• Sigmoid volvulus
• Naniatrogenic trauma with perforations (caused by injury to the abdomen due to holes in the colon), etc.

A thorough pre-operative left hemicolectomy planning is required to make sure you are ready to undergo the surgery.

• A thorough evaluation of your heart, intestine, liver, and other blood tests are done to ensure you are in the right health for the surgery.
• A pre-operative workup is required to be followed to evaluate the stage of cancer.
• Doctors usually perform a full colonoscopy to recognize the synchronous lesions. During this time, all lesions are tattooed to help your surgeon identify them while performing the resection.
• Bowel preparation is started the day before the left hemicolectomy surgery to empty the bowel of waste. Only a liquid-diet is allowed on the day of the surgery. All oral intakes are stopped from the night of the surgery day, except a few instructed medications that should be taken with a small sip of water.
• Preoperative antibiotics are given to the patient to prevent infections during and before the surgery.

The procedure is performed under general anaesthesia. The patient is also given a good muscle relaxant and a Foley catheter is connected to the bladder to measure the output of urine during the surgery. Next, the surgeons use an orogastric tube to decompress the stomach of the patient. The entire abdomen is prepared with an antiseptic solution. Once done, a sterile draping is used to get access to the rectal area and to the abdomen. A midline laparotomy (surgical incision) is created to get access to the left colon.

A thorough examination of the abdominal cavity is done for any metastic lesions. Also, the liver surface is examined for any palpable lesion. Based upon the locations of the lesions, the surgeons determine the length of the colon resection.

The procedure includes resection of the left transverse colon that lies in the middle colic vessels up to the rectum. Usually, a minimum of 12 lymph nodes are considered for resection when performing a left hemicolectomy. Most surgeons prefer a lateral approach to perform a colectomy resection.

After the surgery, you are kept under observation in the recovery room. After the anaesthesia wears off, you are taken to the hospital bed where you stay for days until you regain normal bowel function.

In the first few days, you will receive liquid nutrition, but gradually your switched to a solid diet. If the surgery involves an ileostomy or colostomy to attach the intestine to the outside of the abdomen, you will need to take care of your stoma. An ostomy nurse is hired who will instruct you regarding this.

After being discharged, it will take a couple of more weeks for you to recover from left hemicolectomy procedure. If case of any complications, consult with your doctor immediately.