Open Right Hemicolectomy

The patient is a [age]-year-old [male/female] with [indication] presenting for open right hemicolectomy. The risks, benefits, and alternatives were discussed with the patient, and informed consent was obtained.

A [tumor/mass] was identified in the [cecum/ascending colon/hepatic flexure] measuring approximately [___] cm. The mesentery was [uninvolved / with palpable lymph nodes]. The liver, peritoneum, and remaining abdomen were [without evidence of metastatic disease / with lesions noted]. [Additional findings or none].

The patient was brought to the operating room and placed supine. General endotracheal anesthesia was induced without difficulty. A Foley catheter was placed. A surgical timeout was performed confirming patient identity, procedure, operative site, allergies, and administration of prophylactic antibiotics.

The abdomen was prepped and draped in sterile fashion. A midline laparotomy was performed from [xiphoid/epigastrium] to the umbilicus [and extended as needed]. Abdominal exploration was performed and the findings confirmed. A self-retaining retractor was placed.

The right colon was mobilized by incising the peritoneal reflection along the white line of Toldt from the cecum to the hepatic flexure. The hepatocolic ligament was divided. The mesocolon was elevated off the retroperitoneum, sweeping Gerota's fascia and the duodenum posteriorly. The right ureter and gonadal vessels were identified and swept posterolaterally.

Using a medial-to-lateral approach, the ileocolic artery and vein were ligated with [0-silk ties / hem-o-lok clips] and divided at their origins, achieving a high ligation. The right branch of the middle colic artery [and vein] was similarly identified, ligated, and divided. The terminal ileum was divided approximately 10 cm from the ileocecal valve with a [GIA linear stapler]. The transverse colon was divided at the [hepatic flexure/right transverse colon] with a [GIA stapler].

The specimen was removed and passed off the field. A side-to-side [functional end-to-end] ileocolonic anastomosis was fashioned by aligning the antimesenteric borders of the ileum and colon and firing a [GIA-75 mm] stapler through enterotomies. The common enterotomy was closed with a [TA stapler / two-layer hand-sewn technique using 3-0 Vicryl inner layer and 3-0 silk Lembert outer layer]. The anastomosis was inspected and confirmed to be widely patent, without tension, bleeding, or leak. The mesenteric defect was closed with [interrupted 2-0 silk sutures].

The abdomen was irrigated with warm saline. Hemostasis was confirmed. The fascia was closed with running [#1 looped PDS] suture. Skin was closed with [staples / 4-0 Monocryl]. Sterile dressings were applied.