Open Right Colectomy

Abstract

The open surgical approach to colon cancer surgery is still necessary in some cases. The results of open surgery are time-tested to be both effective and safe and may lag behind minimally invasive approaches with respect to only early postoperative recovery outcomes. The primary objectives of the operation are to remove the cancer with adequate surgical margins and to perform an appropriate lymphadenectomy. An open right hemicolectomy is typically a straightforward operation, but knowledge of the anatomy is necessary to avoid major complications. In patients with normal or low body mass index, the length of the incision for open right hemicolectomy can be similar to the length of the extraction site incision for the laparoscopic approach. This chapter provides a detailed, step-by-step description of the surgical technique for an open right colectomy.

Key Operative Steps

• 1. Use a midline or transverse abdominal incision.

• 2. Explore the abdomen and ensure absence of metastatic disease.

• 3. Mobilize the colon by incising the white line of Toldt from the cecum to the hepatic flexure.

• 4. Divide the omental attachments to the proximal transverse colon.

• 5. Divide the mesentery with sutures or energy device.

• 6. Align the terminal ileum with the transverse colon.

• 7. Use a gastrointestinal anastomosis stapler to create an ileocolostomy.

• 8. Use a second firing of the stapler to close the enterotomy and divide the operative specimen.