title: Primary and secondary restorative proctocolectomy for familial adenomatous polyposis: complications and long-term bowel function.
abstract: OBJECTIVE
  The aim of the study was to evaluate intra-operative difficulties, complications and long-term bowel function in polyposis patients undergoing conversion of an ileorectal anastomosis to an ileoanal pouch, compared with patients with a primary ileoanal pouch operation.
  
  
  METHODS
  A national register-based retrospective study was performed with clinical follow-up and a questionnaire on long-term bowel function.
  
  
  RESULTS
  There were 84 patients in the study: 59 (70%) had a primary pouch operation and in 25 (30%) a secondary pouch procedure was attempted. This was abandoned, in one case, leaving 24 patients who had a successful secondary restorative proctocolectomy. The median (range) follow-up was 123 (0-359) months. There were no intra-operative difficulties in the 59 primary operations, but intra-operative difficulties were reported in nine of 25 secondary operations (P < 0.001). Complications within 1 month of surgery occurred in six of 59 primary operations and in none of 24 secondary operations (P < 0.001); and late surgical complications occurred in eight of 55 primary operations and in eight of 24 secondary operations (P = 0.13). The only difference in bowel function was a lower frequency of nocturnal defaecation after secondary pouch formation (P = 0.02).
  
  
  CONCLUSIONS
  Reoperation with proctectomy after a previous ileorectal anastomosis and conversion to restorative proctocolectomy is feasible in polyposis patients, with morbidity and functional results similar to those seen after a primary pouch operation.
authors.affiliation: The Danish Polyposis Register and the Surgical Departments at Hvidovre University Hospital, Copenhagen, Denmark. sbulow@dadlnet.dk
authors.forename: S
authors.initials: S
authors.lastname: Bülow
authors.forename: H
authors.initials: H
authors.lastname: Højen
authors.forename: S
authors.initials: S
authors.lastname: Buntzen
authors.forename: K L
authors.initials: KL
authors.lastname: Larsen
authors.forename: L
authors.initials: L
authors.lastname: Preisler
authors.forename: N
authors.initials: N
authors.lastname: Qvist
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D003082:Colectomy; D039021:Colonic Pouches / Q000502:physiology*; D003672:Defecation / Q000502:physiology; D003718:Denmark; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D016737:Proctocolectomy, Restorative / Q000009:adverse effects; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D055815:Young Adult