Colectomy

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1. Colectomy By solomon (MD,R)

2. variety of terms are used to describe different types of colectomy Ileocolic Resection describes a limited resection of the terminal ileum, cecum, and appendix It is used to remove disease involving these segments ( e.g., ileocecal Crohn’s disease) and benign lesions or incurable cancers arising in the terminal ileum, cecum, and, occasionally, the appendix If curable malignancy --more radical resections, such as a right hemicolectomy The ileocolic vessels are ligated and divided A primary anastomosis is created between the distal small bowel and the ascending colon It is technically difficult to perform an anastomosis at or just proximal to the ileocecal valve ; therefore, if the most distal ileum needs to be resected , the cecum is generally also removed

3. Right Colectomy used to remove lesions or disease in the right colon and is oncologically the most appropriate operation for curative intent resection of proximal colon carcinoma The ileocolic vessels, right colic vessels, and right branches of the middle colic vessels are ligated and divided Approximately 10 cm of terminal ileum are usually included in the resection A primary ileal -transverse colon anastomosis is almost always possible

4. Extended Right Colectomy An extended right colectomy may be used for curative intent resection of lesions located at the hepatic flexure or proximal transverse colon A standard right colectomy is extended to include ligation of the middle colic vessels at their base The right colon and proximal transverse colon are resected, and a primary anastomosis is created between the distal ileum and distal transverse colon Such an anastomosis relies on the marginal artery of Drummond If the blood supply to the distal transverse colon is questionable , the resection is extended distally beyond the splenic flexure to well perfused descending colon where the ileocolic anastomosis can be performed safely

5. Transverse Colectomy Lesions in the mid and distal transverse colon may be resected by ligating the middle colic vessels and resecting the transverse colon , followed by a colocolonic anastomosis However , an extended right colectomy with an anastomosis between the terminal ileum and descending colon may be a safer anastomosis with an equivalent functional result

6. Left Colectomy For lesions or disease states confined to the distal transverse colon, splenic flexure, or descending colon, a left colectomy is performed The left branches of the middle colic vessels , the left colic vessels, and the first branches of the sigmoid vessels are ligated A colocolonic anastomosis can usually be performed

7. Extended Left Colectomy An extended left colectomy is an option for removing lesions in the distal transverse colon In this operation , the left colectomy is extended proximally to include the right branches of the middle colic vessels Sigmoid Colectomy Lesions in the sigmoid colon require ligation and division of the sigmoid branches of the inferior mesenteric artery In general, the entire sigmoid colon should be resected to the level of the peritoneal reflection and an anastomosis created between the descending colon and upper rectum Full mobilization of the splenic flexure is often required to create a tension-free anastomosis

8. Total and Subtotal Colectomy Total or subtotal colectomy is occasionally required for patients with fulminant colitis, attenuated FAP, or synchronous colon carcinomas The ileocolic vessels, right colic vessels, middle colic vessels, and left colic vessels are ligated and divided The superior rectal vessels are preserved If it is desired to preserve the sigmoid, the distal sigmoid vessels are left intact , and an anastomosis is created between the ileum and distal sigmoid colon ( subtotal colectomy with ileosigmoid anastomosis) If the sigmoid is to be resected, the sigmoidal vessels are ligated and divided, and the ileum is anastomosed to the upper rectum (total abdominal colectomy with ileorectal anastomosis) If an anastomosis is contraindicated , an end ileostomy is created, and the remaining sigmoid or rectum is managed either as a mucus fistula or a Hartmann’s pouch

9. Proctocolectomy Total Proctocolectomy In this procedure, the entire colon, rectum , and anus are removed, and the ileum is brought to the skin as a Brooke ileostomy

10. Schwartz 11 th ed.