Surgical Technique and Difficult Situations from Alain Gainant (Conventional)

Abstract

The right hemicolectomy is defined as the excision of the colon vascularised by the superior mesenteric artery. The resection includes the last 10 cm of the terminal ileum, the cecum, the ascending colon, the hepatic flexure and the right third of the transverse colon. We carry out a mobilisation of the colon before the ligation and section of the vascular pedicles. In fact, the no-touch isolation technique has not demonstrated its efficacy [1]. One study suggests that it could enable a reduction in frequency of hepatic metastases, but would increase that of systemic and local relapses, and would have no effect on survival [2]. For these reasons, the initial ligation of the vessels is not routinely recommended in curative colectomies for cancer by the French Society of Digestive Surgery [3]. The ileocolic and right vessels are ligated at the origin from the superior mesenteric artery and vein, respectively. The central ligation of blood vessels which results in an increased retrieval of lymph nodes and the complete excision of the mesocolon (CME in analogy to the TME concept) is recommended. The CME is performed by carrying out a sharp separation of the perineum of the mesocolon (visceral fascia) from the retroperitoneal plane with preservation of this fascia. With this concept, lymph node harvesting is maximised [4], and the visceral fascia of the specimen of colonic resection is intact. This is of prognostic relevance [5]. This surgical technique has been shown to decrease local recurrence rates [6]. Intestinal continuity is then established by a side-to-side stapled anastomosis.