To describe a technique for colopexy via a left ventral paramedian incision and report postoperative clinical outcomes. Retrospective case series. One hundred fifty-six thoroughbred broodmares treated with a colopexy through a left ventral paramedian incision between 1999 and 2015. Medical records were reviewed for postoperative complications and survival to discharge. The survival rate at 1 year after surgery was based on the medical record, progeny record, or client telephone conversation. Progeny records were reviewed to assess reproductive performance. T tests, χ2 tests, logistic regression, and Kaplan-Meier survival curves were used to identify prognostic factors. The rates of postoperative recurrence of large colon volvulus and colon rupture were 1.2% and 3%, respectively. Ninety-three percent of mares that were treated were discharged alive from the hospital, and 78% were alive 1 year after surgery. The diagnosis of 1 of the following complications increased the risk of death within 1 year: systemic inflammatory response syndrome (SIRS), diarrhea, and/or thrombophlebitis (odds ratio [OR] 4.76). Sixty-six percent of mares that were pregnant at the time of colopexy and discharged alive from the hospital produced a live foal. The percentage of live foals produced each year that the mare was bred after colopexy was 67%. Thoroughbred mares treated with colopexy via a left paramedian incision had a good prognosis for survival and continued use as a broodmare. SIRS, diarrhea, or jugular thrombophlebitis affected long-term survival in this population. Colopexy via a left paramedian incision is a suitable alternative to colopexies requiring a second incision or creating adhesions between the colon and the linea alba in thoroughbred mares.