RIGHT HEMICOLECTOMY

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my operations

How I did It?

Operative Technique:

Ø      Patient supine under General Anesthesia

Ø      Asepsis and antisepsis technique

Ø      Sterile drapes placed

Ø      Midline incision made

Ø      Findings noted

Ø      Umbilical tape ligature applied proximal and distal to the tumor

Ø      Right paracolic peritoneum divided using either metzenbaum and electrocautery

Ø      Ureter identified

Ø      Ascending and transverse colon mobilized

Ø      Ileal mesentery divided

Ø      Ileocolic vessels identified, isolated, doubly ligated and divided

Ø      Intestinal/Allen clamps placed 10cm of terminal ileum

Ø      Middle colic vessels identified

      For cecal masses – left branch of middle colic artery preserved and the                                      right branch divided and ligated just beyond the bifurcation

      For masses near hepatic flexure – middle colic vessels dissected and divided

Ø      Intestinal/Allen clamps applied

      Cecal mass – mid-transverse colon

      Mass near hepatic flexure – distal transverse colon

Ø      Wound protector drape placed into the abdominal incision

Ø      Division of ileum and colon, Intestinal clamps reapplied leaving 10 cm margin fro anastomosis

Ø      Viability of ileum and colon end for anastomosis evaluated

Ø      Two layer end-to-end anastomosis done

      Chromic 3-0 continuous suture using Connell

      Silk 4-0 interrupted Lembert sutures to invert first layer

Ø      Peritoneal lavage

Ø      Hemostasis

Ø      Complete sponge and instrument count

Ø      Peritoneum and Fascia closed using continuous vicryl 0 suture with interrupted external bolsters

Ø      Skin closed partially

Ø      Dry sterile dressing applied