Right Hemicolectomy

What is a right hemicolectomy?

A right hemicolectomy is an operation to remove the right side of your large bowel. This includes the last part of the small bowel (the terminal ileum), the caecum (the pouch at the start of the large bowel where the appendix sits), the ascending colon, and part of the transverse colon — along with the nearby blood vessels and lymph nodes (small glands that can carry cancer cells). Once that section is removed, the remaining small bowel is joined directly to the large bowel. This join is called an ileocolic anastomosis — it becomes your new normal connection, and your bowel keeps working through it.

Mr Nguyen performs this operation using keyhole (laparoscopic) surgery in the vast majority of cases. He uses a carefully refined technique called complete mesocolic excision (CME) — think of it as removing the cancer in its own natural "envelope" of tissue, undisturbed. This approach ensures the lymph nodes around the tumour are captured, which gives the pathologist the most complete picture of your cancer's stage and reduces the chance of it coming back locally.

Who needs this operation?

This operation is recommended when there is a problem in the right side of the bowel that needs to be surgically removed. Common reasons include:

• Cancer of the right colon — in the caecum, ascending colon, or hepatic flexure (the bend near the liver); this is the most common reason for this operation
• Large or complex polyps (adenomas) — growths that are too large or too difficult to remove safely through a camera (colonoscopy)
• Crohn's disease affecting the junction of the small and large bowel, causing a blockage, an abscess, or an abnormal tunnel (fistula) that hasn't responded to medication
• Tumours of the appendix — certain appendix growths that require a wider removal than just the appendix alone
• Poor blood supply (ischaemia), twisting of the bowel (volvulus), or injury involving the right colon
• Bowel blockage — from scar tissue (adhesions), a narrowing (stricture), or the caecum twisting on itself
• Complicated diverticular disease of the right side of the colon — for example a perforation, abscess, or fistula (less common on the right, but it does happen)

How is it performed?

You will be completely asleep under general anaesthesia — you won't feel anything during the operation. It typically takes 2–3 hours.

Keyhole (laparoscopic) approach

Mr Nguyen makes four to five small cuts (each about 5–12 mm — roughly the width of a fingernail) on your tummy. A tiny camera and slender instruments are passed through these openings. He carefully separates the right colon from the surrounding structures and divides the blood vessels feeding that section. The piece of bowel being removed is then brought out through a small protected opening — usually about 4–5 cm near your belly button. Because this cut is so small, it heals well and the risk of a hernia later is low.

Joining the bowel (anastomosis)

Once the diseased section is out, the end of your small bowel and the remaining large bowel are joined together using a special surgical stapler — this is called the ileocolic anastomosis. Mr Nguyen usually creates this join inside your abdomen while still using the keyhole approach (intracorporeal anastomosis). This avoids pulling the bowel out under tension and allows the extraction incision to be kept as small as possible.

Enhanced Recovery After Surgery (ERAS)

Mr Nguyen follows an ERAS (Enhanced Recovery After Surgery) protocol — a structured care program that begins before your operation and continues through your hospital stay. It includes eating and drinking normally for as long as is safe before surgery, using a combination of pain relief methods so you need fewer strong opioids, and encouraging you to drink fluids and move around very early after the operation. Research shows ERAS reduces your hospital stay by 1–2 days and lowers the chance of complications.

Before the operation

• A CT scan of your chest, abdomen, and pelvis to check where the cancer sits and whether it has spread anywhere — this is called a staging scan and helps plan your operation precisely
• Blood tests to check your general health, including a tumour marker called CEA (carcinoembryonic antigen), which is used to monitor your progress after surgery
• You do not usually need to drink a bowel preparation solution before a right hemicolectomy — Mr Nguyen will let you know if this applies to you
• A carbohydrate drink (such as Preload) the evening before and on the morning of surgery, at least 2 hours before your scheduled admission time — this helps your body cope better with the operation and is part of the ERAS program
• A conversation with Mr Nguyen about the small risk of the bowel join not sealing perfectly (an anastomotic leak), and the uncommon possibility of needing a temporary stoma — so you are prepared and not caught off guard

What to expect on the day

• You will be admitted to hospital on the morning of your surgery — the team will be expecting you and will take you through everything step by step
• A small needle will be placed in a vein in your arm (an IV cannula); you'll be given antibiotics to reduce infection risk and a blood-thinning injection to protect against clots
• You will be put to sleep by a specialist anaesthetist — you will feel nothing throughout the operation
• The operation takes approximately 2–3 hours; you will then spend 1–2 hours in the recovery room while your body wakes up, with nursing staff watching over you the whole time
• You will be moved to the surgical ward, where you may have a urinary catheter (a thin tube draining your bladder — you won't feel it) and a drip (IV fluids)
• Small sips of water are offered within the first few hours; you should be able to manage a light diet by the evening of your operation or the following morning
• Getting up and sitting out of bed on the day of surgery or the very next day is one of the most important things you can do — it is a cornerstone of the ERAS recovery program and really does make a difference

Recovery

In hospital (3–5 days): Your diet builds up gradually — from clear fluids on the first day to soft food, then a normal diet, over 2–3 days. Pain is managed with a combination of paracetamol, anti-inflammatory tablets, and if needed, short-term oral opioids. The urinary catheter is usually removed on day 1. Most patients are ready to go home on day 3–5, once they are eating, managing pain with tablets, and walking independently. Many people feel better than they expected.

At home (weeks 1–6):

• Weeks 1–2: Take it easy at home, but do aim for short walks every day from the start — gentle movement is the single best thing for your recovery. Your wound will be checked at 7–14 days. Stick to a soft, easy-to-digest diet initially and introduce higher-fibre foods gradually as your bowel settles.
• Weeks 2–4: Most people feel well enough to manage most day-to-day tasks at home. Your bowel motions may be looser or more frequent than usual for a few weeks — this is completely normal and settles over 3–6 months as your remaining bowel adjusts to its new role.
• Weeks 4–6: You can usually return to desk work and driving (once you are comfortable and no longer taking opioid pain relief). Please avoid lifting anything heavier than 5 kg for 6 weeks to protect your wounds and internal healing.
• Weeks 6–8: Most people are back to their pre-surgery baseline — full activity, normal diet, and feeling like themselves again.
• A post-operative review with Mr Nguyen is routinely arranged 2–6 weeks following your procedure, with timing depending on the type of operation — this review is provided at no charge

Your tissue sample (the piece of bowel that was removed) is sent to the pathology laboratory, where specialist doctors examine it in detail. Results confirming your cancer's stage and whether all margins are clear are usually ready within 2 weeks and will be discussed with you at your follow-up appointment. If the results show Stage III cancer (meaning cancer cells were found in the lymph nodes), you will be referred to a medical oncologist to discuss a course of adjuvant chemotherapy — an additional treatment to reduce the chance of the cancer returning.

Longer-term, Mr Nguyen will arrange regular check-up appointments — at least every six months — which include a clinic visit, blood tests, imaging scans, and colonoscopy (camera tests of the bowel) at set intervals. This ongoing monitoring is important and gives you the best chance of catching anything early.

Risks and complications

Reading about surgical risks can feel daunting — but it helps to know that right hemicolectomy is a well-established, commonly performed operation with a low complication rate in experienced hands. Most people sail through it. The risks below are listed so you can go into surgery fully informed, not to frighten you.

Common (affecting around 1 in 10–20 patients)

• Changes to your bowel habit — looser stools, going more often, or feeling a sense of urgency in the first 3–6 months. This is your bowel adjusting to its new arrangement. It almost always improves significantly as time passes.
• Wound infection or bruising (haematoma) around the wound — usually managed easily with antibiotics or local wound care; rarely anything serious
• Post-operative ileus — a temporary slowdown of bowel activity where the bowel "goes quiet" for a few days before starting to work again. It is very common after any bowel surgery and usually settles on its own within a few days of sipping fluids and moving around.
• Fatigue — feeling more tired than usual for 2–4 weeks is completely normal. Your body is directing a lot of energy into healing.

Less common (affecting around 1 in 20–50 patients)

• Anastomotic leak — occasionally, the join between your small bowel and large bowel does not seal perfectly and starts to leak. This happens in roughly 2–4 in 100 cases and is more likely in patients who are malnourished, taking steroids, or who have had radiotherapy. If it occurs, you may need a further operation and a temporary ileostomy (a small bag on your tummy) while the join heals — this is usually reversible once things have settled down.
• Significant bleeding needing a blood transfusion or a return to theatre — affects fewer than 2 in 100 patients
• Blood clots (DVT or PE) — deep vein thrombosis (a clot in the leg veins) or pulmonary embolism (a clot reaching the lungs). You will wear compression stockings, receive blood-thinning injections, and be encouraged to walk early — all of which significantly reduce this risk.
• Conversion to open surgery — in about 5–10 in 100 keyhole operations, Mr Nguyen may need to switch to a larger incision to complete the operation safely. This is not a complication — it is a planned decision made in your best interest, and it does not mean anything went wrong.

Rare but serious

• Small bowel obstruction from scar tissue (adhesions) — any abdominal surgery carries a 1–3% lifetime risk of scar tissue causing a bowel blockage later in life; keyhole surgery is associated with a lower risk than open surgery
• Injury to the right ureter (the tube carrying urine from your right kidney to your bladder) — this is rare; Mr Nguyen carefully identifies and protects the ureter throughout the operation

Frequently asked questions

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