Surgical and functional outcomes after colectomy and ileorectal anastomosis in patients with familial adenomatous polyposis

Introduction
Familial adenomatous polyposis (FAP) is a distressing genetic disease for both symptomatic and asymptomatic carriers. Thus, early management is paramount to reduce risk of malignancy. Surgical management options for FAP become more variable; but each option comes with a cost. While restorative proctocolectomy with ileal pouch anal anastomosis is considered the gold standard, further surgeries surpass its advantages after critical selection of candidates. Total colectomy with ileorectal anastomosis (IRA) can be the future gold standard when candidates are wisely selected. This study evaluates the surgical, functional, and oncological outcomes of IRA.
Patients and methods
This study is a prospective cohort study conducted between June 2013 and June 2018 with a minimum follow-up of 12 months and included 33 patients with FAP. All patients underwent total colectomy followed by IRA. Then they were followed up for a mean period of 28.4 months to evaluate the postoperative surgical and functional outcomes as a primary endpoint with evaluation of long-term risk of rectal carcinoma as a secondary endpoint.
Results
Thirty-three patients had total colectomy followed by IRA. Ten patients developed early postoperative complications and seven had late complications. Bowel function was well preserved in 94% of patients and only 30% of the patients continued to use antidiarrheal medications beyond 6 months after the operation. One month postoperatively, the mean of bowel motions was 4.8 a day, which decreased to 2.6 times after 1 year of follow-up. Recurrence of polyposis was detected in 30% of patients, and only one patient had developed rectal malignancy.
Conclusions
With appropriate patient selection, IRA provides better surgical, functional, and oncological outcomes. Patient characteristics and disease features should be considered in surgical decision making.