Transverse Colectomy

Introduction

Transverse colectomy, in isolation, is an uncommon procedure. Potential indications for transverse colectomy include transverse colon cancer, segmental inflammatory bowel disease, and segmental transverse colon ischemia. In contrast, mobilization and resection of the transverse colon—in total or segmental—is commonly performed as a component of a right, left, subtotal, or total colectomy. Familiarity with the potential anatomic variability of this part of the colon, along with knowledge and expertise regarding the different surgical approaches, is critical.

Surgical Principles

Transverse colectomy requires detailed knowledge of the vascular supply of the colon, the anatomy of the hepatic and splenic flexures, and the relationship of the omentum to the colon and stomach. The goal of the operation is to resect the transverse colon and create a tension-free, well-vascularized bowel anastomosis. The procedure usually involves the following steps:

• 1.

  Mobilization of hepatic flexure

• 2.

  Mobilization of splenic flexure

• 3.

  Mobilization of the greater omentum, either off the transverse colon or en bloc with it

• 4.

  Division of middle colic artery and vein

• 5.

  Proximal division of the colon

• 6.

  Distal division of the colon

• 7.

  Re-anastomosis of the divided bowel

The particular order of completing steps 1 to 4 is usually dictated by the operative approach, although it is often easiest to perform the division of the middle colic vessels after the colon and omentum have been completely mobilized.