ILEAL POUCH - ANAL-CANAL ANASTOMOSIS FOR FAMILIAL ADENOMATOUS POLYPOSIS - EARLY AND LATE RESULTS

Objective The objective was to review the early and late results of il eal pouch-anal anastomosis (IPAA) done for patients with familial aden omatous polyposis (FAP). Summary Background Data Patients with FAP wil l have colorectal adenomas develop and die of colorectal cancer if lef t untreated. Ileal pouch-anal anastomosis removes all disease-bearing mucosa while preserving transanal passage of stools. Methods Between 1 981 and 1994, 187 patients with FAP, 11 to 59 years of age with a mean follow-up of 60 months (range, 5-170 months) had proctocolectomy and IPAA at Mayo Medical Center in Rochester, Minnesota. All patients had a proximal anal canal mucosal excision and a hand-sewn anastomosis of the pouch to the anal canal at the dentate line. A temporary ileostomy was used in 85% of the patients. Results No early postoperative death s occurred, although two patients died later of metastatic colorectal carcinoma present al their initial operation. More important, no patie nt had a new cancer develop after IPAA. The overall morbidity after op eration was 24%, with small bowel obstruction being the most common co mplication (13%). Patients had four bowel movements/24 hours and good fecal control, which continued during follow-up. Conclusions The IPAA eradicates the risk of colorectal cancer in patients with FAP. It can be performed with low mortality, acceptable morbidity, and good functi onal results over the long term.