Does a Right Hemicolectomy Remove the Appendix?

A right hemicolectomy is the removal of a portion of the colon because of severe damage or cancer. If the appendix is involved in the degraded portion of the colon, it will be removed along with the length of large intestine.

Right hemicolectomy (right colectomy) is the surgical removal of the right side of the colon along with the fat and surrounding lymph nodes. 

The colon is a long, tubelike, inverted U-shaped abdominal structure measuring about five to six inches in diameter. The right side of the colon consists of 

• Cecum (the first part of your colon connected to the last part of your intestine, terminal ileum)
• Ascending colon (the second part of your colon that runs upwards to transverse colon)
• Right half of the transverse colon (straight, middle part of the colon)

 A hemicolectomy is done if the part of the colon that has turned unhealthy or bad. It is usually performed for the following conditions:

• Cancer of the right colon
• Polyps of the colon 
• Inflammatory bowel disease (Crohn’s disease and sometimes ulcerative colitis)
• Caecal volvulus (twisting of the caecum resulting in loops)
• Severe appendicitis with involvement of the cecum in the inflammatory process
• Cancer of appendix
• Diverticular disease (outpouchings of the colon)

Right hemicolectomy can be performed via the open or the laparoscopic approach: 

• Laparotomy (open surgery): A large incision is made into the abdomen to do the surgery.
• Laparoscopic surgery: Four to five small incisions are made into the abdomen, and a long camera (laparoscope) is inserted in one of the incisions to visualize the internal structures and perform the surgery.

Though the surgeon may discuss with you in advance the type of surgery suitable for you, sometimes they may convert the planned laparoscopic surgery into an emergency open surgery if he comes across an appendicular mass that seems to be cancerous.

• Your surgeon will take your complete history and examine you physically. 
• They will ask you to undergo computed tomography (CT) of the abdomen and pelvis and X-ray of the chest. 
• You may be asked to undergo a test known as full colonoscopy, where a long tube-like camera will be inserted through your anus to visualize your colon.
• You will be counseled about the risks and complications of the surgery.
• You will be given an enema either on the previous night before the surgery or on the morning of the surgery.
• You will be advised to have only a clear-liquid diet the day before, and nothing at all for 12 hours before your operation.
• Only the essential medications are allowed, with a sip of water, on the morning of the procedure.
• Some antibiotics and fluids will be started via intravenous route (IV) on the day of procedure.
• A tube-like structure known as a Foley catheter will be inserted into your bladder through your urethra to collect urine.

• For open right hemicolectomy, an incision of about six inch is made on the right side of your abdomen.
• The surgeon will retrieve your right colon and cut (resect) it and then reconnect the rest of your colon end-to-end (technique called end anastomosis).
• In case of severe appendicitis that has affected the caecum, or in cancer of the appendix, the surgeon will also cut the appendix along with the right colon and connect what's left of your colon to your small intestine.
• The surgical wound will be stapled or stitched with surgical threads (sutures) and then covered with a bandage.

• You will be shifted to the surgical ward and monitored for several hours after the surgery.
• You will not be allowed to eat for 24 hours after the surgery. 
• Intravenous fluids and antibiotics are continued for up to 24 hours.
• After 24 hours, you can have clear liquids as tolerated.
• The Foley catheter is removed two to three days after the procedure. 
• You will be encouraged to walk and move around after two days.
• You will be shifted to a soft diet (foods that are easy to chew and swallow) as soon as you pass gas and stools.
• Depending upon how well you tolerate the soft diet and how fast your bowel function bounces back to normal, you will be discharged within three to seven days of your surgery.
• Follow-up is usually scheduled 10-14 days after discharge.

A hemicolectomy is major surgery. You may not be able to get back to normal activities for four to six weeks or even more afterward if you suffer from any of its complications.

The possible complications of open right hemicolectomy include:

• Wound infection
• Leaking from the reconnected colon
• Paralytic ileus (loss of muscle functioning of the colon)