title: Different surgical strategies in the treatment of familial adenomatous polyposis: what's the role of the ileal pouch-anal anastomosis?
abstract: OBJECTIVE
  Restorative coloproctectomy (RCP) with ileal pouch-anal anastomosis (IPAA), is one of the surgical responses to the crucial question of prophylactic treatment in familial adenomatous polyposis (FAP). No consensus has been reached, until now, to choose between IPAA and ileo-rectal anastomosis (IRA), the rectal sparing prophylactic colectomy. This paper aims to review the latest issues related to IPAA and highlights its specificities compared to IRA.
  
  
  METHODS
  PubMed database was searched using the following search items: familial adenomatous polyposis, surgery, ileal pouch-anal anastomosis, ileo-rectal anastomosis. Papers published between 1978 and 2010 were selected.
  
  
  RESULTS
  Absence of mortality, acceptable morbidity and good functional results combined to high quality of life have promoted the IPAA technique. New technical issues such as the double stapled technique, mesenteric lengthening, omission of temporary protective stoma can be addressed almost systematically for these patients. A laparoscopic approach, lessening the body image impact, has proven to be as effective and safe as the open approach to perform IPAA. Further advantages of laparoscopic IPAA rely on the lower adhesion formation resulting in less small bowel occlusion. Sexuality, fertility and childbirth are important functional issues often cited as threatened by the pelvic manoeuvres of the IPAA technique which can be prevented by close rectal wall dissection and a laparoscopic approach.
  
  
  CONCLUSIONS
  IPAA offers the best available prophylaxis in FAP patients. Technical enhancements in IPAA will most probably decrease the functional risks. Thus IPAA remains the alternative to IRA for the prophylactic treatment of FAP.Nevertheless, based on the latest evidence, the choice between both procedures is still matter of debate.
authors: Belgian Polyposis Project, Familial Adenomatous Polyposis Association (FAPA), Brussels.
authors: D
authors: D
authors: Leonard
authors: A
authors: A
authors: Wolthuis
authors: A
authors: A
authors: D'Hoore
authors: L
authors: L
authors: Bruyninx
authors: J
authors: J
authors: Van De Stadt
authors: E
authors: E
authors: Van Cutsem
authors: A
authors: A
authors: Kartheuser
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical; D039021:Colonic Pouches; D006801:Humans; D007082:Ileum / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control; D016737:Proctocolectomy, Restorative