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Review
. 1999 Nov;230(5):648-54.
doi: 10.1097/00000658-199911000-00006.

Functional outcome after colectomy and ileorectal anastomosis compared with proctocolectomy and ileal pouch-anal anastomosis in familial adenomatous polyposis

P van Duijvendijk  1 , J F Slors, C W Taat, P Oosterveld, H F Vasen
Affiliations
Review

Functional outcome after colectomy and ileorectal anastomosis compared with proctocolectomy and ileal pouch-anal anastomosis in familial adenomatous polyposis

P van Duijvendijk et al. Ann Surg. 1999 Nov.

Abstract

Objective: To compare the long-term functional results of ileorectal anastomosis (IRA) with those of ileal pouch-anal anastomosis (IPAA) in patients with familial adenomatous polyposis (FAP).

Summary background data: In patients with FAP, hundreds of colorectal adenomas develop, and the patient will die of colorectal cancer if left untreated. The surgeon must choose between colectomy with IRA and restorative proctocolectomy with IPAA. One factor crucial to decision making is the functional outcome after either procedure. To date, studies on this issue have reported conflicting results and have been based on small series of patients.

Methods: To assess various functional variables, a questionnaire was sent to 323 patients with FAP who underwent either IRA or IPAA and who were registered at the Netherlands Foundation for the Detection of Hereditary Tumors. The overall response rate was 86%; the responders comprised 161 patients who underwent IRA and 118 patients who underwent IPAA.

Results: Patients who underwent IRA scored significantly better for daytime and nighttime stool frequency, soiling, occasional passive incontinence, flatus and feces discrimination, stool consistency, and need for antidiarrheal medication. There was no difference with regard to perianal irritation, episodes of bowel discomfort, or dietary restrictions. The functional results according to the aggregate score of the Gastro-Intestinal Functional Outcome Scale, where the items specified above were integrated (0 indicating a poor and 100 a good overall function), were significantly better in patients with an IRA (74.5) than in patients with an IPAA (66.0) (p < 0.01).

Conclusion: The functional outcome after IRA is significantly better than after IPAA. On the basis of these results, IRA might still be considered in patients with a mild phenotypic expression of the disease in the rectum.

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References

    1. Bussey HJR. Family studies, histopathology, differential diagnosis and results of treatment. Baltimore: The Johns Hopkins University Press; 1975.
    1. Lockhart-Mummery JP. The causation and treatment of multiple adenomatosis of the colon. Ann Surg 1934; 99:178–184. - PMC - PubMed
    1. Cooper JC, Jones D, Williams NS. Outcome of colectomy and ileorectal anastomosis in Crohn’s disease. Ann R Coll Surg Engl 1986; 68:279–282. - PMC - PubMed
    1. Moertel CG, Hill JR, Adson MA. Surgical management of multiple polyposis. The problem of cancer in the retained bowel segment. Arch Surg 1970; 100:521–526. - PubMed
    1. Bess MA, Adson MA, Elveback LR, Moertel CG. Rectal cancer following colectomy for polyposis. Arch Surg 1980; 115:460–467. - PubMed

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