Familial adenomatous polyposis: Ileo-anal pouch versus ileo-rectal anastomosis

In this study we describe the presentation, treatment, and complications of 27 FAP patients.
Background: Treatment of Familial adenomatous polyposis (FAP) is centered on early recognition and curative surgery
with either restorative proctocolectomy with ileal-pouch-anal-anastomosis (IPAA) or colectomy with ileo-rectal
anastomosis (IRA).
Patients and methods: All patients diagnosed with FAP at our center from 2008 to 2012 were included in this case
series. Either IPAA or IRA was used for treatment. Complications were recorded for 12 months after the procedure.
Results: Overall 27 patients were included, 12 (44.44%) index patients, and 15 (55.55%) relatives diagnosed by
screening. Eight Index patients presented with rectal bleeding, two with occult fecal blood and two with abdominal
masses found to be desmoid tumors. Nineteen patients were treated by IPAA, 6 with IRA, and 2 were inoperable due to
diffuse desmoid tumors. Daytime stool frequency was the most common side effect (70.37%), followed by bowel
discomfort episodes (55.56%), requiring dietary restrictions (37.4%), passive incontinence (25.93%), soiling (22.22%),
nighttime stool frequency (18.52%), flatus incontinence (16.0%), and anastomosis leakage (3.70%). On average patients
treated by IPAA experienced less complication than those treated by IRA.
Conclusion: compared with previous reports, this series had older age of diagnosis, higher rate of adenocarcinoma at
diagnosis, and fewer side effects after IPAA than IRA. The latter may reflect technique improvement with experience,
and if supported by future studies, will cement IPAA as the treatment of choice in FAP