Early Surgical and Functional Outcome of Total Proctocolectomy and Ileal Pouch in Patient with Familial Adenomatous Polyp

Abstract

Background: Familial adenomatous polyposis (FAP) is the most common adenomatous polyposis syndrome. It is an
autosomal dominant inherited disorder characterized by the early onset of hundreds to thousands of adenomatous
polyps throughout the colon. If left untreated, all patients with this syndrome will develop colon cancer by age 35-40
years. Objectives: to evaluate the feasibility of total procto colectomy and ileal pouch as an option for patients with
FAP by calculating the surgical and functional incidence of complication. Patient and method: A prospective cross
sectional analytical study had been carried out in Gastroenterology and Hepatology teaching hospital and Baghdad
teaching hospital/ Baghdad/ Iraq. The data collection phase extend over a period of 19 months from 1st of august 2016
to 1st of February 2018.(name, age ,gender, phone number and address), family, past medical and past surgical history ,
clinical examination, Investigations ( Hematological, biochemical, -radiological and endoscopic exam) are information
gathered from the patient, before surgical interference. The targeted population underwent 3 surgical options according
to biopsy results and surgeon preference intra operatively: Total proctocolectomy with ileo anal pouch anastomosis
1. Total colectomy with ileo rectal anastomosis.
2. Total proctocolectomy with continant ileostomy .
Statistical Package for Social Sciences (SPSS) version 24 had been used for data analysis, A p-value < 0.05 was
considered statistically. Result: A total of 11 patients involved in the study, 6 males and 5 females, most of them(6
patients) are 18-44 years old, Family history is positive in 10 patients, and negative only in one male patient.
Complications occurred in an equal frequency for fistula, stricture, leak and sepsis with a 9.1 % for each, while there
were no complications of ischemia, pouchitis, and obstruction, 45.5 % of patients developed ileal pouch related
complications, as perianal sepsis in (18.2%), wound infection in (18.2%) also, and intra-abdominal abscess in (9.1%),
Ileostomy done for 7 patients (54%), and has no association with the number of complications developed. there is no
significant association between patient characteristics like age and gender with the number of complications occurred,
family history of FAP also has no association with the number of complications. Conclusion : Restorative
proctocolectomy (RPC) with ileal pouch anal anastomosis (IPAA) is the procedure of choice for patients with familial
adenomatous polyposis (FAP).