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Deciding on an IRA vs. IPAA for FAP

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Difficult Decisions in Colorectal Surgery

Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

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Abstract

Total abdominal colectomy or proctocolectomy is eventually required for nearly all patients with familial adenomatous polyposis (FAP). These operations are most often performed to prevent or treat colon or rectal cancer. Total abdominal colectomy with ileorectal anastomosis (TAC-IRA) is generally recommended for patients who have a low risk of cancer progression in the retained rectum. Less than 1000 colorectal adenomas, and less than 20 rectal adenomas, and no known diagnosis of high-grade dysplasia (HGD) or cancer, are typical scenarios where TAC-IRA is advised. Alternatively, for patients with >1000 colorectal adenomas, or > 20 rectal adenomas, or a diagnosis of HGD or colorectal cancer, proctocolectomy with ileal pouch anal anastomosis (IPAA) or end ileostomy creation is recommended. Operative risk, postoperative complication risk, functional outcomes, the risk of postoperative desmoid tumor formation, and for women, concerns about fecundity, also figure in to the decision on which operation is best for each individual with FAP.

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Authors and Affiliations

  1. University of Colorado Surgery, Aurora, CO, USA

    Samuel H. Lai & Jon D. Vogel

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Correspondence to Jon D. Vogel .

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  1. Medical Center, University of Chicago, Chicago, IL, USA

    Konstantin Umanskiy

  2. Medical Center, University of Chicago, Chicago, IL, USA

    Neil Hyman

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Lai, S.H., Vogel, J.D. (2023). Deciding on an IRA vs. IPAA for FAP. In: Umanskiy, K., Hyman, N. (eds) Difficult Decisions in Colorectal Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-031-42303-1_37

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  • DOI: https://doi.org/10.1007/978-3-031-42303-1_37

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