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The Impact of Technical Factors on Outcome of Restorative Proctocolectomy for Familial Adenomatous Polyposis

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Diseases of the Colon & Rectum

Purpose

This study was designed to assess the impact of technical factors on functional outcomes and complications in patients undergoing restorative proctocolectomy for familial adenomatous polyposis.

Methods

This was a descriptive study on 189 patients undergoing restorative proctocolectomy in a single tertiary referral center between 1977 and 2003. Primary outcomes were major complications, pouch function, and neoplastic transformation in the anal transitional zone.

Results

Pouch construction was J-reservoir (60 percent), W-reservoir (34 percent), or S-reservoir (6 percent), with double-stapled (31 percent) or handsewn anastomosis with mucosectomy (69 percent). Overall pouch survival was 96 percent at five years and 89 percent at ten years, with no differences according to pouch design or anastomotic technique. The incidence of pelvic sepsis was unaffected by anastomotic technique (stapled vs. handsewn; 12 vs. 13 percent) or type of reservoir (J- vs. W- vs. S-pouch; 16 vs. 9 vs. 10 percent). Fistula formation was independent of anastomotic technique (stapled vs. handsewn; 8 vs. 8 percent) and type of reservoir (J- vs. W- vs. S-pouch; 9 vs. 7 vs. 0 percent). The night-time and 24-hour bowel frequencies were similar with the two anastomotic techniques and types of reservoirs. The incidence of polyps at the anal transitional zone was lower with handsewn than with stapled anastomosis (19 vs. 38 percent; P = 0.047).

Conclusions

Restorative proctocolectomy in patients with familial adenomatous polyposis has good functional outcomes and an acceptable rate of complications, which are independent of choice of technique. Handsewn ileoanal anastomosis with mucosectomy seems to reduce the incidence of subsequent neoplasia in the anal transitional zone but does not eliminate the risk of cancer.

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Acknowledgments

The authors thank Kay Neale and the staff of the Polyposis Registry at St. Mark’s Hospital for providing valuable assistance and additional patient follow-up data.

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Authors and Affiliations

  1. Department of Biosurgery and Surgical Technology, Imperial College London, St. Mary’s Hospital, 10th Floor, QEQM Building, Praed Street, London, W2 1NY, United Kingdom

    Alexander C. von Roon M.R.C.S., Paris P. Tekkis M.D., F.R.C.S., Alexander G. Heriot M.D., F.R.C.S. & Richard E. Lovegrove M.R.C.S.

  2. The Polyposis Registry & Department of Surgery, St. Mark’s Hospital, London, United Kingdom

    Alexander C. von Roon M.R.C.S., Paris P. Tekkis M.D., F.R.C.S., Susan K. Clark M.D., F.R.C.S., Alexander G. Heriot M.D., F.R.C.S., Richard E. Lovegrove M.R.C.S., Simona Truvolo M.D., R. John Nicholls M.Chir., F.R.C.S. & Robin K. S. Phillips M.S., F.R.C.S.

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  1. Alexander C. von Roon M.R.C.S.
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  2. Paris P. Tekkis M.D., F.R.C.S.
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  3. Susan K. Clark M.D., F.R.C.S.
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  4. Alexander G. Heriot M.D., F.R.C.S.
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  7. R. John Nicholls M.Chir., F.R.C.S.
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Correspondence to Paris P. Tekkis M.D., F.R.C.S..

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von Roon, A.C., Tekkis, P.P., Clark, S.K. et al. The Impact of Technical Factors on Outcome of Restorative Proctocolectomy for Familial Adenomatous Polyposis. Dis Colon Rectum 50, 952–961 (2007). https://doi.org/10.1007/s10350-006-0872-z

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  • DOI: https://doi.org/10.1007/s10350-006-0872-z

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