Gallagher, M.C.; Phillips, R.K.S.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA28
Academic Journal
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.


Related Articles

  • A comparison of the complication rates between laparoscopic colectomy and laparoscopic low anterior resection. Yamamoto, S.; Fujita, S.; Akasu, T.; Moriya, Y. // Surgical Endoscopy;Oct2004, Vol. 18 Issue 10, p1447 

    Background: This study compared the short-term outcomes, including the complication rate and minimum surgical invasiveness, between patients with colon and rectal carcinomas, who underwent laparoscopic surgery. Methods: A review evaluated 151 patients who underwent laparoscopic colectomy...

  • Two-Stage Surgical Treatment of Unresectable Obstructive Rectal Cancer with Synchronous Hepatic Metastases. Tsimogiannis, Konstantinos E.; Pappas-Gogos, George K.; Nikas, Konstantinos; Stefanaki-Nikou, Stella; Gossios, Konstantinos; Tsimoyiannis, Evangelos C. // American Surgeon;Dec2007, Vol. 73 Issue 12, p1218 

    Unresectable obstructing rectal cancer with synchronous hepatic metastases is usually a fatal disease. This prospective study was scheduled to treat this difficult condition using a multimodal curative strategy combined with a two-stage surgical treatment. Patients with T4N2 or N3M1 rectal...

  • Combining ultrasonic dissection and the Storz operation rectoscope. Lirici, M.M.; Paola, M.; Ponzano, C.; Hüscher, C.G.S. // Surgical Endoscopy;Aug2003, Vol. 17 Issue 8, p1292 

    Background:Transanal endoscopic microsurgery (TEM) allows a precise, full-thickness resection of rectal tumors anywhere within the rectum. Unfortunately, the standard TEM technique needs complex and rather expensive equipment, demands high skill, and is attended by bleeding and oozing that may...

  • Gasless, video endoscopic transanal excision for carcinoid and laterally spreading tumors of the rectum. Nakagoe, T.; Ishikawa, H.; Sawai, T.; Tsuji, T.; Jibiki, M.; Nanashima, A.; Yamaguchi, H.; Yasutake, T. // Surgical Endoscopy;Aug2003, Vol. 17 Issue 8, p1298 

    Background:The aim of this study is to determine whether gasless, video endoscopic transanal-rectal tumor excision (gasless VTEM) is a valid treatment for rectal carcinoid and laterally spreading tumors (LST).Methods:Eighty-four patients with an adenoma, adenocarcinoma (Tis/T1), or carcinoid...

  • Vertical versus Transverse Incision in Low Anterior Resection for Rectal Cancer. Zheng Liu; Guiyu Wang; Yinggang Chen; Yihui Wang; Qiang Li; Rui Huang; Xishan Wang // American Surgeon;Feb2013, Vol. 79 Issue 2, p215 

    The article discusses a case study which compared vertical and transverse incision for laparotomy of the lower abdomen. The study involved patients with rectal cancer who underwent low anterior resection (LAR) through a vertical or transverse incision at a hospital from March 1, 2009 to August...

  • Hand-Sewn Coloanal Anastomosis for Distal Rectal Cancer: Long-Term Clinical Outcomes Baik, Seung Hyuk; Kim, Nam Kyu; Lee, Kang Young; Sohn, Seung Kook; Cho, Chang Hwan // Journal of Gastrointestinal Surgery;Jul2005, Vol. 9 Issue 6, p775 

    As the oncologic safety of coloanal anastomosis (CAA) has been proved by many other authors, the incidence of CAA following ultralow anterior resection has increased. The purpose of this study is to evaluate the functional outcome and complications of patients who underwent ultralow anterior...

  • Transanal Endoscopic Microsurgery for T1 and T2 Rectal Cancers: A Meta-Analysis and Meta-Regression Analysis of Outcomes. SGOURAKIS, GEORGE; LANITIS, SOPHOCLES; GOCKEL, INES; KONTOVOUNISIOS, CHRISTOS; KARALIOTAS, CHARILAOS; TSIFTSI, KATERINA; TSIAMIS, ACHILLEAS; KARALIOTAS, CONSTANTINE C. // American Surgeon;Jun2011, Vol. 77 Issue 6, p761 

    The objective of this study is to assess transanal endoscopic microsurgery (TEM) as a surgical strategy for stage I rectal cancer. The literature lacks level I and level II evidence of the oncologic competence of TEM. Three randomized controlled, one prospective, and seven retrospective...

  • Sphincter-Preserving Operations Following Preoperative Chemoradiation: An Alternative to Abdominoperineal Resection for Lower Rectal Cancer? Jung Wook Huh; Eun Joo Jung; Yoon Ah Park; Kang Young Lee; Seung-Kook Sohn // World Journal of Surgery;Jun2008, Vol. 32 Issue 6, p1116 

    Sphincter-preserving operations (SPO) for lower rectal cancer are on the rise. In the study reported here, we compared the oncologic outcomes of patients who underwent sphincter-preserving operations following preoperative chemoradiation for lower rectal cancer with the outcome for patients who...

  • Laparoscopic rectal surgery for middle and lower rectal cancer. Fukunaga, Yosuke; Higashino, Masayuki; Tanimura, Shinnya; Takemura, Masashi; Fujiwara, Yushi // Surgical Endoscopy;Jan2010, Vol. 24 Issue 1, p145 

    The usefulness of laparoscopic low anterior resection for middle and lower rectal cancer remains controversial. Retrospective assessment was performed on 98 patients (51 with middle and 47 with lower rectal cancer) who underwent laparoscopic rectal surgery since 1998. Total mesorectal excision...


Read the Article


Sign out of this library

Other Topics