A hemicolectomy is a surgical procedure in which approximately half of the colon is removed. This surgery is very serious and accompanied with a risk of major complications, and it is not undertaken lightly. Classically, hemicolectomies are used when the bowel is so damaged or diseased that leaving it in place could threaten the patient's well being. This procedure can be performed by a general surgeon, who may open up a laparotomy incision in the abdomen, or use laparoscopy for a less invasive procedure.
In a right hemicolectomy, the ascending portion of the colon is removed, while a left hemicolectomy involves removal of the descending colon. Reasons for this procedure can include severe trauma, colon cancer, polyps in the colon, inflammatory bowel disease, bowel infarction, and diverticulitis. Usually the surgeon uses medical imaging, including examination of the bowels with a camera, along with patient interviews, to determine whether or not this procedure is indicated.
After the surgeon has removed the bowel, he or she is faced with two choices. In some patients, the portions of the bowel may be reconnected for a complete bowel repair. Other circumstances may call for a colostomy, in which the bowel is provided with an outlet which drains to a colostomy bag. Both options are accompanied with risks and issues, including the risk of infection in the case of a repair of the bowel, and emotional distress for patients with colostomy bags.
Risks of a hemicolectomy can include the usual risks associated with surgery, such as infection, an adverse reaction to anesthesia, and other complications, along with the risk of leakage of fecal material into the abdominal cavity, which can lead to peritonitis. A skilled surgeon can greatly reduce the risks, and patients can help reduce the risks by talking with the surgeon and anesthesiologist before the procedure, and carefully following aftercare instructions after the surgery to increase their chances of healing well.
After a hemicolectomy, a patient usually needs to observe dietary restrictions which are designed to allow the bowel to heal from the traumatic surgery. Patients may also be directed to take antibiotic medications to prevent the onset of infection. In the case of a procedure which has ended in a colostomy, the patient will be given training in working with the colostomy bag, including training on spotting the signs of infection, handling the bag safely, and discussing the medical device with caregivers.