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Laparoscopic total colectomy for colonic inertia: surgical and functional results

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Abstract

Background

Total colectomy is the surgery of choice for colonic inertia (CI) when medical treatment has failed. Laparoscopic total colectomy has demonstrated to be a feasible technique.

Objective

Present our experience in patients with CI who underwent laparoscopic total colectomy (TC) + ileorectoanastomosis (IRA) and evaluate the functional results and medium-term follow-up after this surgery.

Material and methods

All patients with CI were included in a prospective laparoscopic surgical protocol, from 2002 to 2007. These patients had a complete work-up for chronic constipation (clinical records, barium enema, colonic transit time, defecography, anorectal manometry, small bowel follow through). All patients were evaluated with Wexner’s score for constipation pre- and postoperatively, asked if they would recommend surgery to other patients, and if they were satisfied with the procedure (on a scale from 1 to 10). Statistical analysis was carried out using Student’s T-test.

Results

In this period 20 patients were operated with diagnosis of CI. All patients were females with an average age of 41.5 years (range 18–52 years). Mean operative time was 248 min (range 170–360 min). One (5%) patient was converted to open surgery. The medium time to flatus per anum and feeding was 2 (range 1–6) and 3 (range 2–6) days, respectively. The medium postoperative stay was 7 days. Seven patients (35%) presented surgical postoperative complications (three postoperative ileus, one portal thrombosis, one rectal hemorrhage, one anastomotic leakage, and one hemoperitoneum). There was no postoperative mortality. The average follow-up was 25 months (range 1–60 months). Preoperative Wexner’s constipation score was 22.3 (range 19–29 months) pre surgery and at the end of follow-up was 1.8 (range 0–6) (p < 0.01). The medium level of satisfaction was 8 (range 2–10) and only one patient would not recommend surgery to other patients.

Conclusion

The laparoscopic access is a safe technique with satisfactory functional results after medium-term follow-up.

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Authors and Affiliations

  1. Colorectal Unit, Digestive Surgery Department, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago, Chile

    George Pinedo, Alejandro Jose Zarate, Eduardo Garcia, Maria Elena Molina, Francisco Lopez & Álvaro Zúñiga

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  1. George Pinedo
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  2. Alejandro Jose Zarate
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  3. Eduardo Garcia
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  4. Maria Elena Molina
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  5. Francisco Lopez
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  6. Álvaro Zúñiga
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Correspondence to George Pinedo.

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Pinedo, G., Zarate, A.J., Garcia, E. et al. Laparoscopic total colectomy for colonic inertia: surgical and functional results. Surg Endosc 23, 62–65 (2009). https://doi.org/10.1007/s00464-008-9901-4

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  • DOI: https://doi.org/10.1007/s00464-008-9901-4

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