Overview
Removing the left colon for cancer and diverticular disease.
Left hemicolectomy is the operation that removes the left side of the colon — varying from the splenic flexure to the upper rectum depending on where the disease is. The two most common reasons we recommend it are cancer of the left colon and recurrent or complicated diverticulitis, especially after a perforation, abscess, fistula, or stricture. Large polyps that cannot be removed during a colonoscopy and the unusual case of sigmoid volvulus also bring patients to this operation. After the diseased segment is removed, the remaining colon is sewn or stapled directly to the upper rectum during the same operation.
We perform the great majority of left hemicolectomies minimally invasively — robotically or laparoscopically — through four to five small abdominal incisions. The robot is particularly valuable at the splenic flexure (the bend under the left rib cage) and low in the pelvis where the colon meets the rectum, because the wrist-tipped instruments and 3D vision make precise dissection in narrow spaces easier. For cancer cases, we follow strict oncologic principles: high ligation of the inferior mesenteric vessels at their origin, complete mesocolic excision, and a target of at least 12 lymph nodes for accurate staging.
Who is a candidate?
Most adults with left-sided colon disease are candidates. For cancer, we obtain a staging CT of the chest, abdomen, and pelvis along with carcinoembryonic antigen (CEA) before surgery. For diverticular disease, the conversation usually happens after two or three episodes of diverticulitis — or sooner if there has been a perforation, abscess, fistula, or stricture. Most diverticular patients have their operation in an elective, planned setting with a full bowel prep, which is much safer than emergency surgery during an acute infection. Patients with significant cardiac or pulmonary disease sometimes require an open approach.
How we perform it
Under general anesthesia, four to five small ports are placed in the abdomen. We mobilize the left colon and splenic flexure off the retroperitoneum, taking care to protect the left ureter, the gonadal vessels, and the spleen. The inferior mesenteric artery is divided at its origin for cancer cases, or at a lower level for benign diverticular disease. The colon is divided in healthy tissue proximally (typically in the distal transverse colon) and distally (typically in the upper rectum), and a stapled circular anastomosis is created between them through the anus. The specimen comes out through a small protected incision. Operations typically take 2.5–4 hours.
Recovery
Most patients stay 3–5 nights. You will walk the evening of surgery, sip clear liquids the next morning, and advance to a regular diet over the next day or two as bowel function returns. Stooling may be loose or unpredictable for the first few weeks while the colon adapts to its new length. Desk work resumes at 2–3 weeks; lifting and full activity at 4–6 weeks. For cancer cases, the first surveillance visit is at 2 weeks with the operating surgeon, and a longer-term plan with medical oncology starts shortly after.
Why Florida Surgical
Dr. Shaw is fellowship-trained in surgical oncology and performs robotic left colon resection as a high-volume part of his Broward County practice. Diverticular surgery is a part of nearly every week — the decision about when to operate is as important as the operation itself, and we spend the time to get it right. For cancer cases, we present pathology at multidisciplinary tumor board and coordinate any needed chemotherapy with medical oncology partners.
Frequently asked questions
Will I need a colostomy?
For an elective left hemicolectomy, almost never. The colon and rectum are reconnected during the same operation. A temporary diverting ileostomy is sometimes used when the anastomosis is very low or when the tissue is inflamed from a recent infection — that ileostomy is reversed in a small second operation about 8–12 weeks later.
How long is recovery?
Hospital stay is typically 3–5 days. Desk work resumes in 2–3 weeks; lifting and full activity in 4–6 weeks. Robotic and laparoscopic recovery is much faster than open — the small incisions are much less painful than a midline scar.
Why do I need a bowel prep?
For left-sided operations, an empty and decontaminated colon at the time of anastomosis reduces the risk of surgical site infection and anastomotic leak. We use combined oral antibiotics with mechanical prep the day before surgery, which is supported by strong modern evidence.
What is an anastomotic leak?
A leak is a failure of the new connection between bowel segments to heal. It is uncommon (about 3–5%) and usually presents in the first week with new pain, fever, or rising heart rate. Most leaks can be managed with antibiotics and a drain; a small number need a return to the operating room and a temporary stoma.
Is robotic better than open?
For appropriate patients, robotic and laparoscopic left colectomy give less pain, smaller scars, less blood loss, and faster recovery than open, with equivalent cancer outcomes. The robot is particularly useful at the splenic flexure and deep in the pelvis.