EFFICACY OF THE STRAIGHT ENDORECTAL PULL-THROUGH IN THE MANAGEMENT OFFAMILIAL ADENOMATOUS POLYPOSIS - A 16-YEAR EXPERIENCE

From 1979 to 1995, 27 patients who had familial adenomatous polyposis (FAP) were treated at the authors' institution. Most patients (n = 23) presented as a result of a previous family history of FAP. Eighteen p atients presented with symptomatic colonic disease that included blood y stools (n = 14), diarrhea (n = 10), and abdominal pain (n = 6). Trea tment consisted of a total colectomy, rectal mucosectomy, and straight endorectal pull-through (ERPT) in 26 of 27 patients. One patient pref erred to undergo an ileoanal J pouch reconstruction. A temporary diver ting loop ileostomy was performed in 25 patients and closed at an aver age of 100 days after the ERPT. Follow-up has been achieved in 100% of the patients and ranges from 6 to 182 months with an average of 48 mo nths. Postoperative complications included partial bowel obstruction ( two patients, one requiring enterolysis); and mild pouchitis (one pati ent). Two of the 27 patients required proctectomy and permanent ileost omy procedures, one for rectal cancer that was present microscopically in the initial rectal specimen from the ERPT and the other because of recurrent anastomotic complications. No patient required revision of the straight pull-through to a pouch or takedown of the pull-through a s a result of persistent diarrhea or dissatisfaction. All of the patie nts are continent, and 80% deny any soiling during bouts of gastroente ritis. The mean number of bowel movements reported was 10 per day at t he first postoperative clinic visit with a gradual decreased to six pe r day after a years. Initial use of bulking (62%) and antimotility age nts (88%) decreased significantly over the course of follow-up to 29% and 67%, respectively at the most recent follow-up (average, 48 months ) of each patient. Pelvic sepsis, which occurs in 8% of most series of patients who have pouches, did not occur in any of our patients. Pouc hitis, a common complication with pouches (23%), occurred in only one of the patients and was mild and easily treated medically. This series demonstrates that total colectomy with rectal mucosectomy and straigh t ERPT eliminates the risk of colorectal cancer and achieves continenc e with a low complication rate and excellent functional results and pa tient satisfaction. Copyright (C) 1997 by W.B. Saunders Company.