Hemicorporectomy

Hemicorporectomy, also known as translumbar amputation, is a radical surgical procedure involving the amputation of the body below the waist, transecting the lumbar spine. This results in the removal of the lower limbs, genitalia (both internal and external), urinary system, pelvic bones, anus, and rectum. This surgery is considered highly mutilating and is typically employed as a last resort for individuals experiencing severe and potentially life-threatening conditions such as osteomyelitis, tumors, significant traumas, or intractable decubiti in or around the pelvic area. As of 2009, there have been 66 cases reported in the medical literature, with the most recent operation documented in September 2019.

Indications for Hemicorporectomy

Hemicorporectomy is reserved for extremely severe cases where other treatments have failed or the disease process is advanced and life-threatening. Indications include:

• Osteomyelitis: A severe and persistent infection of the bone.
• Malignant Tumors: Advanced or aggressive cancers in the lower half of the body.
• Severe Trauma: Cases where damage to the lower body is so extensive that recovery is unlikely.
• Intractable Decubiti: Persistent, non-healing ulcers or wounds around the pelvis that have become life-threatening.

Procedure of Hemicorporectomy

Hemicorporectomy is a complex procedure that requires a multidisciplinary team, including vascular surgeons, urologists, orthopedic surgeons, and plastic surgeons. The operation involves several steps, from securing the abdominal aorta to prevent massive blood loss, to amputating the lower body and creating an end colostomy and a urinary diversion.

Prognosis and Quality of Life Post-Hemicorporectomy

Given the radical nature of the procedure, postoperative survival and quality of life depend heavily on the patient’s overall health status, the adequacy of social support, and the extent of rehabilitation services. A key concern is the psychosocial impact of the procedure and ensuring appropriate psychological support is crucial.

Complications and Challenges

Possible complications from hemicorporectomy can be significant and include both physical and psychological difficulties:

• Physical complications: Postoperative complications can include infections, blood clots, and complications from the colostomy or urinary diversion.
• Psychological difficulties: The psychological impact can be substantial given the extreme physical changes resulting from the procedure. Depression, anxiety, and difficulties with body image and self-esteem are common.
• Rehabilitation and long-term care: The rehabilitation process is extensive and often requires specialized care and physical therapy to adapt to life after the procedure. Long-term care needs can be significant and may include ongoing wound care, management of the colostic and urinary diversions, and psychological support.

Ethical Considerations

Given the severity and life-altering consequences of hemicorporectomy, ethical considerations play a significant role in the decision-making process. Informed consent, weighing the benefits and risks, and considering the patient's quality of life are all essential elements in the decision-making process.

See also

• Amputation
• Osteomyelitis
• Tumors
• Pelvis

References

Hemicorporectomy Resources
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