title: Familial adenomatous polyposis: ileo-anal pouch versus ileo-rectal anastomosis.
abstract: OBJECTIVE
  In this study we describe the presentation, treatment, and complications of 27 FAP patients.
  
  
  BACKGROUND
  Treatment of Familial adenomatous polyposis (FAP) is centered on early recognition and curative surgery with either restorative proctocolectomy with ileal-pouch-anal-anastomosis (IPAA) or colectomy with ileo-rectal anastomosis (IRA).
  
  
  METHODS
  All patients diagnosed with FAP at our center from 2008 to 2012 were included in this case series. Either IPAA or IRA was used for treatment. Complications were recorded for 12 months after the procedure.
  
  
  RESULTS
  Overall 27 patients were included, 12 (44.44%) index patients, and 15 (55.55%) relatives diagnosed by screening. Eight Index patients presented with rectal bleeding, two with occult fecal blood and two with abdominal masses found to be desmoid tumors. Nineteen patients were treated by IPAA, 6 with IRA, and 2 were inoperable due to diffuse desmoid tumors. Daytime stool frequency was the most common side effect (70.37%), followed by bowel discomfort episodes (55.56%), requiring dietary restrictions (37.4%), passive incontinence (25.93%), soiling (22.22%), nighttime stool frequency (18.52%), flatus incontinence (16.0%), and anastomosis leakage (3.70%). On average patients treated by IPAA experienced less complication than those treated by IRA.
  
  
  CONCLUSIONS
  compared with previous reports, this series had older age of diagnosis, higher rate of adenocarcinoma at diagnosis, and fewer side effects after IPAA than IRA. The latter may reflect technique improvement with experience, and if supported by future studies, will cement IPAA as the treatment of choice in FAP.
authors.affiliation: Department of General Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Mozafar
authors.affiliation: Department of Internal Medicine Urmia University of Medical Sciences, Urmia, Iran.
authors.forename: Kamran
authors.initials: K
authors.lastname: Shateri
authors.affiliation: Department of Emergency Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Tabatabaey
authors.affiliation: Department of General Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Saran
authors.initials: S
authors.lastname: Lotfollahzadeh
authors.affiliation: Department of General Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Khashayar
authors.initials: K
authors.lastname: Atqiaee
keywords: Familial adenomatous polyposis (FAP); J-pouch; Proctocolectomy