TITLE

PRIMARY RESTORATIVE PROCTOCOLECTOMY FOR FAMILIAL ADENOMATOUS POLYPOSIS

AUTHOR(S)
Gallagher, M.C.; Phillips, R.K.S.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA28
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Introduction: Some surgeons favour colectomy and ileoanal pouch (RPC) as prophylactic surgery in familial adenomatous polyposis (FAP), citing the absent risk of rectal cancer and avoidance of further surgery. However, the disadvantages of early postoperative complications, particularly sepsis, late pouch dysfunction, and reduced fertility should all be considered. Aims: To investigate the long term outcome in a cohort of FAP patients undergoing primary RPC. Methods: All patients undergoing prophylactic colectomy between January 1980 and December 2001 were identified from a single polyposis register. Cases where the primary operation was colectomy with construction of an ileoanal pouch were included, case notes and the registry database being examined to determine outcome. Results: Primary RPC was performed in 59 of 285 patients (21%). Follow up was complete for 58 patients (98%) and for an average of 8 years and 8 months (6 months to 20 years and 7 months). There were 34 males and 25 females, average age at surgery 32 years and 1 month (range 10 years 10 months). 20 patients (35%) suffered at least one early postoperative complication including pelvic sepsis (9), anastomotic leak (3), prolonged small bowel obstruction (4), postoperative haemorrhage (2), pulmonary complications (4), early pouch itis (1), and wound breakdown (1). Five patients required subsequent pouch excision, one For carcinoma, three for pouch evacuation problems and one for chronic pelvic sepsis; all had suffered early postoperative complications. In only one case was revision surgery successful, the remainder being managed with an end ileostomy. Four patients died during follow up, three of these from colorectal carcinoma. Conclusion: Pouch surgery is not without complications. Failed pouch surgery has resulted in an ileostomy in 4% of patients. The choice of primary surgery for FAP remains difficult.
ACCESSION #
9747443

 

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