Long-term follow-up of patients undergoing colectomy for colonic inertia

PURPOSE: Total abdominal colectomy with ileorectal anastomosis has been the procedure of choice for patients with the established diagnosis of colonic inertia. Previous studies with a limited follow-up of only one to two year s have shown acceptable results and a high rate of patient satisfaction. Th e aim of this study was to evaluate the long-term results of total abdomina l colectomy in these patients in terms of complications, bowel function, an d overall patient satisfaction. METHODS: Access to the colorectal registry at the Cleveland Clinic Florida identified all patients who underwent total abdominal colectomy for colonic inertia between 1988 and 1993, with a mini mum of five-year followup. Telephone interviews were designed to assess bow el function, concomitant use of any antidiarrheal medications, postoperativ e complications, persistence or development of preoperative symptoms such a s pain or bloating, and overall satisfaction. Patients were asked to rate t heir outcome as excellent, good, fair, or poor. RESULTS: Fifty patients und erwent total abdominal colectomy for the diagnosis of colonic inertia. Thre e patients died of unrelated causes and 30 (60 percent) were available for follow-up. The mean follow-up was 106 months, ranging from 61 to 122 months . All 30 patients reported the outcome of surgery as "excellent." The avera ge frequency of spontaneous bowel movements was 2.5 (range, 1-6) per day. D uring the period of follow-up, six patients (20 percent) required admission for small-bowel obstruction, three of whom (10 percent) required laparotom y. Four patients complained of mild Pelvic pain, only one of whom had the o nset of pelvic pain postoperatively that persisted until the time of interv iew. In the other three patients the pain was present preoperatively but ha d decreased in intensity since the operation. Two patients (6 percent) stil l required assistance with bowel movements, one by laxatives and the other by enemas. Only two patients (6 percent) needed antidiarrheal medications t o reduce bowel frequency. CONCLUSION: This Long-term follow-up revealed a h igh degree of patient satisfaction and very good bowel habits, with an acce ptable long-term rate of bowel obstruction. Based on these results, total a bdominal colectomy can be recommended to patients with well-established col onic inertia with expectations of sustained benefit up to ten years after s urgery.