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International Journal of Colorectal Disease

, Volume 10, Issue 1, pp 6–9 | Cite as

Surgery for the teenager with familial adenomatous polyposis: ileo-rectal anastomosis or restorative proctocolectomy?

  • Y. Ziv
  • J. M. Church
  • J. R. Oakley
  • E. McGannon
  • V. W. Fazio
Original Articles

Abstract

Increasing numbers of polyposis registries have led to more young patients being diagnosed with familial adenomatous polyposis (FAP). To provide guidelines for selecting the appropriate surgical procedure in teenagers (10–19 years), we compared the results of colectomy and ileo-rectal anastomosis (IRA, n=17 patients) to the results of resrorative proctocolectomy and ileal pouch-anal anastomosis (IPAA, n=7 patients). Charts were reviewed to obtain data on the operative technique, blood loss and transfusions, hospital stay (including the time for ileostomy closure), and early (within 30 days of surgery) and late complications. Functional results (bowel movements per 24h, use of antidiarrheal drugs, seepage, and fecal incontinence) and quality of life were evaluated prospectively with a questionnaire and physical examination. The median follow-up time was 49 months (range, 6 to 95 months) after IRA, and 36 months after IPAA (range, 4 to 87 months). Although restorative proctocolectomy and IPAA, is a longer (5.75 vs 3.1 hours), more bloody (500 vs 300 mL blood loss), and more complex operation with a longer hospital stay (12 vs 7 days) than IRA (P=0.008, P=0.006, P=0.02, respectively), no significant difference (P>0.05) was found between groups concerning the complication rate or quality of life. For teenagers with FAP and rectal carpeting, large rectal adenomas, curable cancer in the upper two-thirds of the rectum, or who are unavailable for follow-up, we recommend a restorative proctocolectomy and IPAA. For the other patients, the decision whether to perform IRA or restorative proctocolectomy with IPAA depends on the patient's desire and the surgeon's skill.

Keywords

Adenoma Ileal Fecal Incontinence Familial Adenomatous Polyposis Nous Avons 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

La multiplication des registres de polypose a permis de diagnostiquer un nombre croissant de sujets jeunes proteurs d'une polypose adénomateuse familiale (FAP). Afin d'établir des recommandations dans la sélection du traitement chirurgical approprié chez des adolescents (10–19 ans), nous avons comparé les résultats de la colectomie et de l'anastomose iliéo-rectale (IRA, n=17 patients) aux résultats de procto-colectomie avec rétablissement de la continuité par l'intermédiaire d'une poche iléoanale (IPAA, n=7 patients). Les dossiers ont été revus afin d'obtenir des données sur la technique opératoire, les pertes sanguines et les transfusions, la durée de séjours hospitaliers (incluant la période nécessaire pour la fermeture de l'iléostomie), ainsi que les complications précoces (à moins de 30 jours de l'opération) et les complications tardives. Les résultats fonctionnels (nombre de selles par 24 h, usage de médications anti-diarrhéïques, fuites et incontinence fécale) et la qualité de la vie ont été évalués prospectivement à l'aide d'un questionnaire et de consultations de contrôle. Le suivi moyen a été de 49 mois (de 6 à 95 mois) après l'IRA et de 36 mois après l'IPAA (de 4 à 87 mois). Bien que la colo-poctectomie avec rétablissement de la continuité par IPAA soit plus longue (5,75-heures vs 3,1) plus sanglante (500 ml pertes sanguines vs 300 ml) et plus complexe avec un séjour hospitalier plus long (12 jours vs 7 jours) que l'IRA (P=0.008, P=0.006 et P=0.002), nous n'avons pas observé de différence P>0.05 entre les deux groupes en ce qui concerne le taux de complecations et la qualité de vie. Nous recommandons une colo-proctectomie avec rétablissement de la continuité par une IPAA chez des adolescents porteurs d'une polypose adénomateuse familiale et de tapis d'adénome du rectum présentant des cancers curables des deux tiers supérieurs du rectum chez lesquels le follow-up ne pourra que difficilement être assuré. Dans les autres cas, la décision de réaliser une IRA ou une procto-colectomie avec IPAA dépend des souhaits du patient et de l'expérience du chirurgien.

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Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • Y. Ziv
    • 1
  • J. M. Church
    • 1
  • J. R. Oakley
    • 1
  • E. McGannon
    • 1
  • V. W. Fazio
    • 1
  1. 1.Department of Colorectal Surgery, Desk A-111The Cleveland Clinic FoundationClevelandUSA

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