Familial Adenomatous Polyposis: Surgical Approaches

Abstract

Familial adenomatous polyposis (FAP) is a well-recognized precancerous lesion for which large bowel resection is the only possibility of obtaining a cure. The senior author’s personal experience with the surgical treatment of 12 patients suffering from this disease is analyzed, and forms the basis for a discussion of what might be considered the ‘ideal’ approach. A restorative proctocolectomy with ileoanal anastomosis (technique I) was performed in 4 patients; total colectomy followed by ileorectal anastomosis (technique II) in 5, and panproctocolectomy with a definitive Brooke ileostomy in 3 (technique III). There was no operative mortality. Two patients from technique II (40%) developed rectal cancer 4 and 5 years after surgery, respectively, for which an abdominoperineal proctectomy with a conventional ileostomy was performed. The long-term results among patients of technique I, in terms of anorectal function, are excellent, suggesting that this modality is probably the most appropriate approach to FAP when dealing with a patient under 45 years of age.