Right Hemi-Colectomy
SECTION 3.00 PRELIMINARIES
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3.01 CHECK YOU HAVE THE CORRECT PATIENT
3.02 CHECK YOU HAVE THE CORRECT SIDE
3.03 CHECK YOU HAVE A DIAGNOSIS
The diagnosis may be certain, based on histology of a carcinoma from biopsy.
Quite often the diagnosis is uncertain. The histology may be suspicious without clear evidence of malignancy. Sometimes the histology is benign with a diagnosis of a dysplastic cells, benign polyp, normal mucosa, because the biopsy has missed the tumour. Decide to continue on clinical grounds.
Clinical, radiological or other imaging evidence may be all that is available, particularly in Crohn's disease.
3.04 CHECK THE CONSENT
The patient needs to agree to have more extensive surgery than the planned right hemicolectomy if there is spread into other tissues and organs.
These include, small bowel resection, stoma, excision of fistulas, right nephrectomy, oophorectomy and possible hysterectomy.
3.05 CHECK THE FUNCTION OF THE LEFT KIDNEY
IS SATISFACTORY
This is important if the right kidney needs to be removed.
See the intravenous urogram or ultrasound scan.
3.06 CHECK THERE IS NO OTHER PROCEDURE TO DO
3.07 CHECK A DIATHERMY PAD IS ATTACHED TO ON THE RIGHT THIGH
3.08 CHECK A NASO-GASTRIC TUBE HAS BEEN INSERTED
3.09 CHECK THE PATIENT HAS HAD ANTIBIOTIC
Metronidazole 1gm intravenously
Cefuroxime 1.5gm intravenously.
3.10 ANAESTHESIA
General anaesthesia is the norm.
Epidural anaesthesia may be given in addition.
Local anaesthetic will be given by the surgeon before incising the abdomen.
Spinal anaesthesia may be preferable to a general anaesthetic at the anaesthetists discretion.