In which patients do I perform IRA, and why?

Evaluation of 28 years of surgical treatment of children and young adults with familial adenomatous polyposis

“…A system has been designed, in which patients receive a telephone call yearly, to make sure an appointment for endoscopic screening is made. This cohort confirms the importance of regular follow-up screening, after IPAA as well as after IRA [5,6,12,34]. In the case of poor refractory compliance with follow-up screening, early conversion from IRA to IPAA may be considered.…”

“…In patients whom IRA was performed despite the presence of more than 10 rectal adenomas, further data analysis showed that these operations were mainly performed before 1991, when in our center, IRA was still the preferred operation in children. Nowadays, it is recommended to construct IPAA if more than 20 rectal adenomas are present and in case of severe dysplasia or carpeting of polyps [10][11][12].…”

“…Because the remaining rectum is still at risk for the development of cancer, postoperative endoscopic surveillance is needed after surgery. The procedure should be reserved for patients with less than 5 to 20 small rectal adenomas [4,[10][11][12][13]. Ileal-pouch anal anastomosis is technically a more complicated operation with a higher morbidity.…”

Colectomy and Ileorectal Anastomosis is still an Option for Selected Patients with Familial Adenomatous Polyposis

“…6 A similar selective choice of procedure has been supported by others. 4,5,7,9,10 In 2003, a Scandinavian study demonstrated that the female fecundity was reduced by approximately 50 percent after IPAA, whereas it was unaffected after IRA 30 ; this new recognition further supports a selective recommendation of IRA in young women.…”

“…Some centers recommend IPAA as the procedure of choice for all FAP patients, 1-3 whereas others recommend that the decision about surgical procedure should be individualized according to patient age and to clinical and genetic severity of the disease, thus recommending IRA in young patients with a mild genotype and phenotype and IPAA in severe cases. [4][5][6][7][8][9][10] In 2000 Church et al 11 presented data that support the hypothesis that today the risk of metachronous rectal cancer after IRA is probably much lower than in the past, because patients with severe polyposis will now have an IPAA, thus leaving only mild cases with an anticipated lower rectal cancer risk for IRA. The purpose of this study was to evaluate this hypothesis on the basis of an update of a previously published four-nation follow-up study after IRA.…”