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What is meant by Hemicorporectomy?

In medicine (surgery), hemicorporectomy can also be called as translumbar amputation and “halfectomy”.

– It is a radical surgery in which the body below the waist is amputated that transects the lumbar spine.
– Hemi is generally used to refer to one of two sides like e.g., hemiplegia, which affects the arm and leg on one side of the body.
– The first hemicorporectomy was attempted by Charles S. Kennedy in 1960.

This includes the removal of:
– legs,
– the genitalia (internal and external),
– urinary system,
– pelvic bones,
– anus,
– rectum.

What kind of patients is recommended to undergo this procedure?
– It is a severely mutilating procedure recommended only as a last resort for patients.
– It is suggested to the patients with severe and potentially fatal illnesses like osteomyelitis, tumors, severe traumas and intractable decubiti in, or around, the pelvis.
– Cancer patients who need:
1. Extended radical mastectomy.
2. Radical gastrectomy.
3. Pancreatectomy.
4. Pelvic exenteration.
5. The ‘Commando Operation’ (tongue, jaw and neck dissection).
6. Bilateral back dissection.
7. Hemipelvectomy.
8. Hemicorporectomy or translumbar amputation.

Indications
– The operation is most often performed to treat spreading cancers related to that of the spinal cord and pelvic bones.
– Trauma affecting the pelvic girdle (“open-book fracture”).
– Uncontrollable abscess or ulcers of the pelvic region (causing sepsis).
– Other locally uncontainable conditions.

The Surgical Procedure
– It is often done in two stages.
– It is also possible to conduct the surgery in one stage.
– The first stage is the discontinuation of the waste functions in colostomy (rectum) and ileal conduit (bladder).
– The second stage is the amputation.

What are the points to be considered when undergoing this procedure?
– With the removal of almost half of the circulatory system, cardiac function needs to be closely monitored.
– A new blood pressure set-point develops.
– Removal of large parts of the colon can lead to loss of electrolytes.
– A calculated measurements of renal function (such as the Cockroft-Gault formula) are unlikely to reflect actual activity of the kidney.

Post Treatment
– Extensive physiotherapy and occupational therapy are necessary.
– The design and construction of bucket prosthesis.

Prosthetic
– Following a hemicorporectomy, patients are fitted with a socket-type prosthetic often referred to as a bucket.
– Early bucket designs often presented significant pressure problems for patients.
– New devices have incorporated with an inflatable rubber lining composed of air pockets.
– These evenly distribute pressure based on the patient’s motions.
– Two openings at the front of the bucket create space for the colostomy bag and the ileal conduit.

Postoperative management requires
– Particular attention to fluid replacement,
– Temperature control,
– Pulmonary care.

Long-term management issues involve:
– Hypertension,
– Weight gain,
– Temperature control,
– Stoma management,
– Skin care

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