Laparoscopic total colectomy for colonic inertia: surgical and functional results.
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.


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.


CONCLUSIONS
The laparoscopic access is a safe technique with satisfactory functional results after medium-term follow-up.
Pinedo
George
G
Colorectal Unit, Digestive Surgery Department, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago, Chile. gpinedo@med.puc.cl
Zarate
Alejandro Jose
AJ
Garcia
Eduardo
E
Molina
Maria Elena
ME
Lopez
Francisco
F
Zúñiga
Alvaro
A
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D002908:Chronic Disease; D015331:Cohort Studies; D003082:Colectomy; D003248:Constipation / Q000601:surgery*; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D010535:Laparoscopy; D008875:Middle Aged; D020127:Recovery of Function; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult