Left Colectomy (Open, Laparoscopic)

Procedure Snapshot

• Indication: Left-sided diverticulitis, obstruction, malignancy.
• Expected duration: ___
• Special instruments: Stapler, vessel-sealer, bowel clamp, retractor.

Step Workflow — Open

1. Midline incision; explore abdomen.
2. Mobilize left colon (incise white line of Toldt).
3. Identify and protect left ureter and gonadal vessels.
4. Divide inferior mesenteric vessels at appropriate level.
5. Resect diseased segment; perform stapled end-to-end or side-to-side anastomosis.

Step Workflow — Laparoscopic

1. Ports: umbilical + LLQ + suprapubic.
2. Medial-to-lateral dissection along IMA pedicle.
3. Identify ureter; mobilize colon; divide vessels.
4. Exteriorize and staple anastomosis extracorporeally.

Key Pimp Questions

• Q: Blood supply to left colon?
  A: IMA → left colic → marginal artery of Drummond.
• Q: Leak risk factors? A: Hypoperfusion, tension, malnutrition (PMID 32847953).

Critical Anatomy

• Landmarks: Left ureter, IMA, marginal artery.
• Danger zones: Pelvic nerves, splenic flexure traction injury.

Informed Consent Highlights

• Leak __ (PMID 32847953), bleeding __, ureteral injury ___.

Post-op Considerations

• Early ambulation (ERAS); monitor for flatus and stool before diet.

References

• Chassin’s, Colorectal section. Clinical Scenarios, Colon chapter.
• Braga 2020 (PMID 32847953).