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


BACKGROUND
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).


CONCLUSIONS
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.
van Duijvendijk
P
P
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. p.vanduijvendijk@amc.uva.nl
Slors
J F
JF
Taat
C W
CW
Oosterveld
P
P
Vasen
H F
HF
D011125:Adenomatous Polyposis Coli / Q000453:epidemiology / Q000601:surgery*; D000328:Adult; D003082:Colectomy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000453:epidemiology; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D009378:Neoplasms, Multiple Primary / Q000453:epidemiology; D016737:Proctocolectomy, Restorative; D012086:Reoperation; D011795:Surveys and Questionnaires; D016896:Treatment Outcome