Hemicolectomy Surgery in Ankara, Turkey

Hemicolectomy is the surgical removal of the right or left half of the colon. This operation is generally performed due to colon cancer, inflammatory bowel diseases, or traumatic injuries. After surgery, the remaining bowel ends are joined together to maintain digestion.

While right hemicolectomy is preferred for removing the cecum and ascending colon, left hemicolectomy involves the removal of the descending colon. The method to be selected is determined according to the location and extent of the disease.

When laparoscopic hemicolectomy is performed with a minimally invasive technique, postoperative pain and recovery time are reduced. This method enables patients to return to their daily lives more quickly and achieve better cosmetic results.

Post-hemicolectomy patient follow-up is critical in terms of monitoring bowel habits and reorganizing the nutrition plan. Regular check-ups and patient-specific medical approaches are required to reduce the risk of complications.

You can contact Prof. Dr. Ebru Soy, one of the doctors performing Hemicolectomy Surgery in Ankara, to get information about Hemicolectomy Surgery prices, the process, and the hospital where Hemicolectomy Surgery is performed.

What is hemicolectomy surgery?

Although hemicolectomy technically means the removal of approximately half of the large intestine, this procedure is not a treatment method specific only to cancer patients. Of course, colon cancer is the most common reason we perform this surgery and constitutes a large part of our surgical practice. However, as general surgeons, we also resort to this method in many different scenarios that threaten the patient’s health, reduce quality of life, or carry a risk of turning into cancer in the future.

Conditions that disrupt the structure of the intestine, do not respond to medical treatment, or pose a life-threatening risk make surgical intervention inevitable. Sometimes formations that appear benign but carry dangerous potential, and sometimes suddenly developing emergencies, bring us to the operating room door. The main conditions requiring this surgery are as follows:

• Colon cancer
• Inflammatory bowel diseases
• High-risk polyps
• Cecal volvulus
• Complicated diverticulitis
• Ischemic colitis
• Appendicitis complications
• Bowel perforations
• Traumatic injuries

Each condition on this list requires its own specific approach. For example, in a tumor located on the right side, we perform a “Right Hemicolectomy” and remove the cecum, ascending colon, and part of the transverse colon. If the disease is slightly further along at the bend under the liver, we proceed to a more extensive procedure called “Extended Right Hemicolectomy.” This is not merely removing a piece of tissue; it is a personalized roadmap drawn according to the patient’s anatomy and the location of the disease.

How does the preoperative preparation and ERAS protocol process work?

In the old surgical understanding, patients were kept fasting for days and their intestines were completely emptied with strong laxatives. This would take the patient into surgery tired, exhausted, and dehydrated. However, the “Enhanced Recovery Protocols,” medically known as ERAS, which we have adopted in modern surgery, have completely changed this understanding. We now know that a patient should be prepared for surgery like an athlete about to run a marathon. The body’s energy stores should be full, muscles should be strong, and the patient should feel psychologically ready.

In this process, we aim to maximize our patients’ physiological reserves. As recommended by authorities such as the American Society of Colon and Rectal Surgeons, mechanical cleansing alone is not enough; we minimize the risk of infection by reducing the bacterial load in the intestine with oral antibiotics. In addition, by giving our patients special carbohydrate-containing drinks just before surgery, we prevent the body from entering a state of starvation stress and break insulin resistance. The main components of this approach are as follows:

• Mechanical bowel preparation
• Use of oral antibiotics
• Carbohydrate loading
• Nutritional support
• Physical exercises
• Smoking cessation
• Correction of anemia
• Blood sugar control

These items are the building blocks that enable the patient to recover much faster after surgery. A well-nourished patient with high body resistance overcomes surgical trauma much more easily. Our goal is not to confine the patient to bed but to get them back on their feet as soon as possible.

What is the difference between emergency surgery and planned surgery?

In the world of surgery, timing is everything. There is as much difference between performing an operation under planned, elective conditions and under emergency conditions as between night and day. Emergency situations usually arise during crises such as bowel obstruction (obstruction) or perforation. At these moments, the body is under great stress, the patient has usually lost fluids, and infection markers are elevated. Statistics clearly show that complication rates are higher in cancer surgeries performed under emergency conditions and that the likelihood of opening a temporary bag (stoma) increases.

For this reason, especially in patients presenting with right colon obstruction, our first preference is not to immediately take up the scalpel. If possible, we follow a strategy we call “Bridge Therapy.” In this strategy, our priority is to relieve the obstruction and comfort the patient. With the help of a stent placed inside the intestine, the obstruction is relieved, the patient becomes able to use the toilet normally, and nutrition begins. This buys us time. After the patient has recovered, nutrition has improved, and edema has decreased, we perform laparoscopic or robotic surgery under much safer conditions. However, in some cases, we do not have the luxury of waiting. The conditions that necessitate emergency surgery are as follows:

• Bowel perforation
• Severe peritonitis
• Uncontrolled bleeding
• Bowel necrosis
• Obstructions where stenting is not possible

In such a situation, we choose the safest path without hesitation. The patient’s life is above all. If necessary, we bring the intestine out to the abdominal wall (open a stoma) and, after the patient overcomes the life-threatening condition, we restore the intestine with a second operation.

Why is Complete Mesocolic Excision (CME) important in cancer surgery?

Cancer surgery is not just about cutting out the tumor visible to the eye. The real battle is against microscopic spread that cannot be seen. This is where the concept of “Complete Mesocolic Excision” (CME) comes into play. To understand this, you can think of the intestine as a letter inside an envelope. Cancer cells travel through the lymphatic channels within this envelope (mesocolon). If the surgeon tears or fragments this envelope during surgery, there is a risk that cancer cells may spill into the abdomen.

Our task is to remove this envelope as a single, intact package without damaging even its thinnest membrane. In addition, we perform another critical maneuver called “Central Vascular Ligation” (CVL). We ligate the vessels feeding the tumor not close to the intestine but at their origin from the main artery (the primary branch arising from the aorta). Because lymph nodes follow the vessels. The more centrally we ligate the vessel, the more lymph nodes we clear. The advantages provided by this technique are as follows:

• Less local recurrence
• Longer survival
• More lymph nodes
• Cleaner margins
• Safer surgery

This technique is the most important moment when the surgeon demonstrates anatomical knowledge and mastery. Scientific studies prove that surgeries performed in accordance with CME principles significantly reduce the rate of cancer recurrence.

What is the difference between D2 and D3 dissection in lymph node clearance?

The number and location of lymph nodes removed in cancer surgery are of vital importance in determining the stage of the disease and deciding whether additional treatment is necessary. In surgery, we code these levels of clearance as D1, D2, and D3. D1 includes only the nodes at the base of the intestine and is never sufficient for cancer surgery. The standard and accepted approach is D2 dissection. D2 involves removing the lymph nodes around the tumor and up to the midline of the vessels supplying it. This is the gold standard for most patients and provides adequate clearance.

D3 dissection is a much more advanced level. Here, the surgeon reaches the deepest and most central lymph nodes surrounding the main vessels (Superior Mesenteric Artery and Vein). This region is one of the most dangerous areas of the body; it is located just behind the pancreas and next to the duodenum. It is true that more lymph nodes are removed with D3 dissection (for example, 31 instead of 27). However, scientific data show that routinely performing D3 on every patient does not create a miraculous difference in survival. Moreover, vascular injuries in this region can have very serious consequences. Therefore, we prefer D3 dissection in the following situations:

• Suspicious central lymph nodes
• Young patients
• Advanced-stage tumors
• Specialized centers

Our approach is “Safe Radicalism.” That is, clearing the cancer without putting the patient at risk. A standard D2 dissection and a flawless CME technique are the safest and most effective treatment methods for the vast majority of patients.

How do robotic surgery and laparoscopy techniques provide advantages?

Open surgeries, where the abdomen is opened from top to bottom and recovery takes weeks, have now given way to technological methods. Under the umbrella of what we call “Minimally Invasive Surgery” are Laparoscopy and Robotic Surgery. Both methods are performed by entering through small incisions (ports) made in the abdominal wall. However, Robotic Surgery takes what laparoscopy can do one step further, giving the surgeon superhuman abilities.

In the robotic system (for example, the da Vinci system), the surgeon is not at the patient’s bedside but at a console. The robot’s arms can perform maneuvers that the human wrist cannot, rotate 540 degrees, and do not transmit even the slightest tremor of the surgeon’s hand to the patient. In addition, the image is three-dimensional and high resolution; we see tissues magnified 10 times. These features provide tremendous advantage, especially when working in narrow areas, around vessels, or while suturing. The concrete benefits offered by robotic surgery are as follows:

• Less blood loss
• Less pain
• Fewer complications
• Shorter hospital stay
• Faster recovery
• Less scarring
• Higher precision
• Lower conversion to open surgery

Especially in obese patients, individuals with previous abdominal surgeries and adhesions, or cases where the tumor location is challenging, the convenience provided by the robot is undeniable. The likelihood of converting to open surgery during the operation is almost close to zero in robotic surgery. This is a major advantage in terms of patient safety.

Should the bowel connection procedure (Intracorporeal Anastomosis) be performed inside the abdomen?

After the diseased bowel segment is removed, the procedure of joining the two remaining healthy ends together is called “anastomosis.” This is one of the most critical stages of the operation because this connection must not leak and must function well. In traditional laparoscopic methods, a 5–6 cm incision is made in the abdomen to connect the bowel, the intestine is pulled out, sutured or stapled outside, and then pushed back in. We call this Extracorporeal (outside the body) Anastomosis. However, pulling the intestine outside causes tissue stretching, edema, and trauma.

The current and superior approach is “Intracorporeal Anastomosis” (ICA). In this technique, the intestine is never brought outside. All cutting, joining, and suturing procedures are performed entirely inside the abdominal cavity with the help of robotic or laparoscopic instruments. Preventing the intestine from coming into contact with the cold air and trauma outside provides a major advantage. The benefits this method offers patients are as follows:

• Less bowel paralysis
• Faster gas passage
• Smaller incision site
• Lower hernia risk
• Less pain
• Better cosmetic result

The more gently we treat the intestines, the faster they respond. Thanks to the connection performed inside the abdomen, the intestines do not “sulk,” begin working much faster, and the patient can transition to solid food much earlier. This is the most important factor that directly shortens the length of hospital stay.

How is the risk of organ injury managed during surgery?

Every surgical intervention inherently carries certain risks. In right hemicolectomy surgery, the issue we are most concerned about is injury to surrounding organs. The abdominal cavity is a complex area where many vital structures are located adjacent to each other. Especially when working on the right side, the right ureter (the channel that carries urine from the kidney to the bladder) and the duodenum are very close to the surgical field. A large tumor, obesity, or adhesions due to previous inflammations can distort the anatomy and increase these risks.

To manage these risks, we never compromise surgical discipline. First, we stay in the correct plane by following anatomical guides such as “Toldt’s White Line.” If we progress in the correct tissue layer, the organs separate from each other naturally and the risk of injury decreases. In very challenging cases, we place illuminated ureteral catheters preoperatively to clearly identify their location. In addition, we apply a principle we call the “Critical View of Safety”; before cutting any structure, we expose it until we are one hundred percent sure of what it is. The methods we apply to increase safety are as follows:

• Correct dissection plane
• Following anatomical landmarks
• Illuminated ureteral catheters
• Critical view of safety
• Careful vascular separation
• Early awareness

If, despite all our efforts, visibility is not clear or bleeding control becomes difficult, we do not insist. Converting to open surgery is not a failure but the safest step taken to protect the patient. Oncological principles and patient safety are never compromised.

How are postoperative recovery and pain control ensured?

When the surgery ends, our work does not end; in fact, the recovery process has just begun. In this process, our greatest enemy is pain. A patient in pain does not want to move, cannot take deep breaths, and becomes demoralized. In the past, patients were given plenty of morphine-derived (opioid) medications for pain relief. Although these drugs relieved pain, they stopped bowel movements, caused nausea, and made the patient drowsy. This delayed recovery.

Now, we apply a modern approach called “Multimodal Analgesia,” in which drugs with different mechanisms of action are used together. The goal is to reduce opioid use to zero. Our strongest weapon for this is the ultrasound-guided “TAP Block.” This local anesthesia applied to the nerves of the abdominal wall allows the patient to pass the first 24 hours after surgery very comfortably. A patient without pain walks early, and when the patient walks, the intestines work. Our postoperative goals are as follows:

• Early mobilization (walking)
• Opioid-free painkillers
• TAP block application
• Early fluid intake
• Early solid food
• Rapid discharge

In fact, we begin giving our patients water and clear liquids on the evening of the surgery. The next morning, we encourage them to get out of bed and walk in the corridor. The rule of “fasting for days after surgery” is no longer valid. Without waiting for bowel sounds, we increase nutrition as long as the patient tolerates it. This approach reduces the risk of infection and allows the patient to feel like someone who is recovering rather than someone who is ill.

Frequently Asked Questions

For which diseases is hemicolectomy surgery performed?

Hemicolectomy is performed for colon cancer, Crohn’s disease, diverticulitis, and large polyps that need to be removed. The diseased colon segment is removed from the right or left side while maintaining the continuity of the digestive system.

What is the difference between right and left hemicolectomy?

In right hemicolectomy, the cecum, ascending colon, and sometimes part of the transverse colon are removed. In left hemicolectomy, the descending colon and sigmoid colon are removed. Which side will be removed is determined according to the location of the disease.

How is anastomosis performed after hemicolectomy?

After the diseased colon segment is removed, the remaining bowel ends are sutured together. This procedure is called anastomosis and requires careful follow-up against leakage after surgery.

How does bowel habit change after hemicolectomy?

After surgery, the frequency of bowel movements may temporarily increase. After right hemicolectomy, stool may be more watery, while this change is more limited on the left side. Over time, bowel function returns to normal.

Is a temporary stoma opened after hemicolectomy?

In most hemicolectomy surgeries, a stoma is not required. However, in emergency surgeries or in cases where the risk of anastomotic leakage is high, a temporary protective stoma may be opened and closed at the appropriate time.

How should nutrition be arranged after hemicolectomy?

A liquid diet is started in the first days, then soft foods are introduced. Gas-forming, fibrous, or hard-to-digest foods should be avoided for a while. The nutrition plan is adjusted according to the patient’s tolerance level.

How long does abdominal pain last after hemicolectomy?

Mild to moderate pain after surgery is normal and decreases within a few days. Pain can be controlled with analgesics. Severe or progressively increasing pain may be a sign of complications.

When is discharge after hemicolectomy?

Hospital stay is generally 4–7 days. This period may be shorter in laparoscopic surgeries. Criteria such as passing gas, oral nutrition, and mobilization must be met for discharge.

How is quality of life affected after hemicolectomy?

Mild digestive changes may occur in the first months after surgery, but most patients return to normal life over time. Removal of part of the colon generally does not lead to serious long-term functional loss.

Can reoperation be required after hemicolectomy?

Rarely, if complications such as anastomotic leakage, infection, or bowel obstruction develop, reoperation may be necessary. In addition, if the disease recurs, further surgery may be planned.

How Long Does Hemicolectomy Surgery Take?

Hemicolectomy surgery generally takes between 2 and 4 hours. The duration of the operation may vary depending on which part of the colon will be removed (right or left hemicolectomy), the patient’s general health condition, and whether the surgeon prefers a laparoscopic or open method.

Which Doctor or Department Should Be Consulted for Hemicolectomy?

For this operation, a general surgery specialist should be consulted, preferably one experienced in gastrointestinal surgery or colorectal surgery.