There are two alternative methods:
- At emergency surgery of ileus/perforation an extended right-sided hemicolectomy is performed in addition to resection of the intestinal segment around the left colic flexure to the lower part of the descending colon.
- At elective surgery one is dividing distally in the same level, but cecum ascending colon and the right part of transverse colon may be retained if the bowel is released and a good anastomosis without any tensioning is performed.
In both cases a standard lymph node resection is performed.
Colica media is divided centrally and colica sinistra is divided by mesenterica inferior.