Colectomy and ileorectal anastomosis or restorative proctocolectomy for familial adenomatous polyposis

The choice of prophylactic operation for familial adenomatous polyposis (FAP) is controversial. Colectomy and ileorectal anastomosis (IRA) is a time-honoured procedure but has recently been replaced by restorative proctocolectomy in many centres. The objective of this study was to compare the operative and functional outcomes following IRA and restorative proctocolectomy (RPC). The morbidity rate, operation time, blood loss and hospital stay were compared in 99 IRA and 33 RPC patients. The functional outcome following IRA and RPC were compared in 22 sex-matched pairs. The median hospital stay was 11 days after IRA and 12 days after RPC. The operation time was longer in RPC (216 vs 182 min) and blood loss greater (1253 vs 634 ml). The complication rates were 30% after RPC and 18% after IRA. None of 23 primary RPC operations failed, but two (20%) of the 10 patients with secondary RPC following IRA finally received a permanent ileostomy. The overall functional satisfaction was excellent in 82% and 88% after RPC and IRA, respectively. The mean basal anal pressure was higher in the IRA groups (54 vs 39 cmH2 O, P = 0.004) and the stool frequency slightly less (4.7 vs 5.8, P = 0.06) than after RPC. There is little difference in short-term surgical or functional results between IRA and RPC but a secondary RPC may be unsuccessful. Therefore, primary RPC may be a better option in FAP than IRA.