Laparoscopic Subtotal Colectomy for Colonic Inertia

Colonic inertia is an uncommon condition, usually occurring in women in the third decade of life. Severity of symptoms may lead some patients to a surgical consultation. This is a retrospective review of 14 patients who underwent laparoscopic subtotal colectomy for colonic inertia, performed by a single surgeon from August 1993 to November 2002. The mean age of the patients was 38.5 years (range 26-50 years); 93% of the patients were women. The common presenting symptoms included abdominal pain (93%), bloating (100%), constipation (100%), and nausea (57%). Median duration of symptoms before surgery was 4.5 years (range 1-30 years). Subtotal colectomy was completed laparoscopically in 13 patients. There was one conversion (7%) because of adhesions. Eleven patients (78.6%) had undergone previous abdominal surgery. The mean operating room time was 153 minutes (range 113-210 minutes). The median time to full bowel action was 2 days. One patient developed postoperative small bowel obstruction that required open exploration. Complete follow-up was available for 11 patients at a median follow-up of 18 months (range 2-96 months). Ninety-one percent of the patients reported excellent satisfaction with surgery, and their bowel movement frequency changed from 1.2 (+/-0.2) per week preoperatives to 17.2 (+/-2.9) per week postoperatively (P < 0.001). Three patients (27%) continued to report abdominal pain and 3 patients (27%) continued to require laxatives postoperatively. Laparoscopic subtotal colectomy provides excellent symptom relief in patients with colonic inertia who do not respond to medical measures.