title: The impact of technical factors on outcome of restorative proctocolectomy for familial adenomatous polyposis.
abstract: OBJECTIVE
  This study was designed to assess the impact of technical factors on functional outcomes and complications in patients undergoing restorative proctocolectomy for familial adenomatous polyposis.
  
  
  METHODS
  This was a descriptive study on 189 patients undergoing restorative proctocolectomy in a single tertiary referral center between 1977 and 2003. Primary outcomes were major complications, pouch function, and neoplastic transformation in the anal transitional zone.
  
  
  RESULTS
  Pouch construction was J-reservoir (60 percent), W-reservoir (34 percent), or S-reservoir (6 percent), with double-stapled (31 percent) or handsewn anastomosis with mucosectomy (69 percent). Overall pouch survival was 96 percent at five years and 89 percent at ten years, with no differences according to pouch design or anastomotic technique. The incidence of pelvic sepsis was unaffected by anastomotic technique (stapled vs. handsewn; 12 vs. 13 percent) or type of reservoir (J- vs. W- vs. S-pouch; 16 vs. 9 vs. 10 percent). Fistula formation was independent of anastomotic technique (stapled vs. handsewn; 8 vs. 8 percent) and type of reservoir (J- vs. W- vs. S-pouch; 9 vs. 7 vs. 0 percent). The night-time and 24-hour bowel frequencies were similar with the two anastomotic techniques and types of reservoirs. The incidence of polyps at the anal transitional zone was lower with handsewn than with stapled anastomosis (19 vs. 38 percent; P=0.047).
  
  
  CONCLUSIONS
  Restorative proctocolectomy in patients with familial adenomatous polyposis has good functional outcomes and an acceptable rate of complications, which are independent of choice of technique. Handsewn ileoanal anastomosis with mucosectomy seems to reduce the incidence of subsequent neoplasia in the anal transitional zone but does not eliminate the risk of cancer.
authors.affiliation: Department of Biosurgery and Surgical Technology, Imperial College London, St. Mary's Hospital, 10th Floor, QEQM Building, Praed Street, London, W2 1NY, United Kingdom.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: von Roon
authors.forename: Paris P
authors.initials: PP
authors.lastname: Tekkis
authors.forename: Susan K
authors.initials: SK
authors.lastname: Clark
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Heriot
authors.forename: Richard E
authors.initials: RE
authors.lastname: Lovegrove
authors.forename: Simona
authors.initials: S
authors.lastname: Truvolo
authors.forename: R John
authors.initials: RJ
authors.lastname: Nicholls
authors.forename: Robin K S
authors.initials: RK
authors.lastname: Phillips
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome