CHOICE OF PROPHYLACTIC SURGERY FOR THE LARGE-BOWEL COMPONENT OF FAMILIAL ADENOMATOUS POLYPOSIS

The surgical options for treating the large bowel component of familia l adenomatous polyposis are total proctocolectomy, colectomy with ileo rectal anastomosis, and restorative proctocolectomy, with or without m ucosectomy. Although the first of these eradicates all mucosa at risk, it carries several disadvantages, not least of which is a permanent i leostomy. There is little to choose functionally between the other two operations. The choice should be based on the perceived risk of cance r developing in any residual rectum; the factors influencing this risk are discussed.