Comparison of ileal pouch-anal anastomosis and ileorectal anastomosis in patients with familial adenomatous polyposis

PURPOSE: The aim of this study was to evaluate the surgical complications a nd long-term outcome and assess the functional results and quality of life after ileorectal anastomosis and ileal pouch-anal anastomosis in patients w ith familial adenomatous polyposis. METHODS: From 1980 to 1997, 131 patient s with familial adenomatous polyposis were operated on or were followed up or both at the Familial Gastrointestinal Cancer Registry at Mount Sinai Hos pital. Demographic and operative data were prospectively collected in the i leal pouch-anal anastomosis group, and retrospectively in the ileorectal an astomosis group. A questionnaire or telephone interview or bath were undert aken to evaluate functional outcome and quality of life. RESULTS: The ileor ectal anastomosis group consisted of 60 patients (mean age, 31 years; mean follow-up, 7.7 years). In the ileal pouch-anal anastomosis group there were 50 patients (mean age, 35 years; mean follow-up, 6 years). There were no s tatistically significant differences with respect to anastomotic leak rate in ileal pouch-anal anastomosis us. ileorectal anastomosis (12 vs. 3 percen t; P = 0.21), risk of small-bowel obstruction (24 vs. 15 percent; P = 0.58) , and risk of intra-abdominal sepsis (3 vs. 2 percent; P = 0.86). Reoperati on rate was similar in the two groups (14 vs. 16 percent; P = 0.94). Twenty -one patients (37 percent) with ileorectal anastomosis were converted to il eal pouch-anal anastomosis (12 patients) or proctocolectomy (9 patients), b ecause of rectal cancer (5 patients), dysplasia (1 patient), or uncontrolla ble rectal polyps (15 patients). Two pelvic pouches were excised, and anoth er one was defunctioned. Information regarding functional results and quali ty of life was obtained in 40 patients (66.6 percent) in the ileorectal ana stomosis group and in 43 patients (86 percent) in the ileal pouch-anal anas tomosis group. Patients with ileorectal anastomosis had a significantly bet ter functional outcome with regard to nighttime continence and perineal ski n irritation. But otherwise, functional results and quality of life were si milar. CONCLUSIONS: Although ileorectal anastomosis has a better functional outcome, ileal pouch-anal anastomosis may be preferable because of the low er longterm failure rate. Ileorectal anastomosis is still an option in pati ents with familial adenomatous polyposis with rectal polyp sparing and good compliance for follow-up.