Abstract
PurposeTo achieve excellent postoperative bowel function in familial adenomatous polyposis (FAP) patients, it is important to reconstruct the digestive tract. The aim of this study is to preliminarily discuss the advantages of total proctocolectomy with straight ileoanal anastomosis (TPC-SIAA) plus pedicled omental transposition for FAP.MethodsA retrospective study was carried out in two hospitals analysing data for FAP patients who underwent surgical treatments between 2015 and 2021. Perioperative outcomes and early and mid-term anal functions were analysed.ResultsAfter excluding 4 patients who underwent total proctocolectomy with permanent ileostomy, 10 patients were enrolled in the study. Among the 10 patients, 3 received TPC-SIAA plus pedicled omental transposition, 3 received total proctocolectomy with ileal pouch-anal anastomosis (TPC-IPAA), and 4 received total colectomy with ileal pouch-rectal anastomosis (TC-IPRA). Except for one case conversion to laparotomy, laparoscopic surgery was performed for the other cases. The incidence of early postoperative complications was apparently higher with pouch anastomosis (57.1%) than straight anastomosis (0%). Frequencies of bowel movement and low anterior resection syndrome (LARS) score were higher for TPC-SIAA than the other two surgical procedures in the early term; over time, however, the frequencies of bowel movement and LARS score both showed a decreasing trend. In addition, combined with anorectal pressure detection and magnetic resonance imaging defecography at the 3rd month after TPC-SIAA plus pedicled omental transposition, defecation coordination was good. The dynamics and receptivity of the new rectum tended to be as expected.ConclusionAlthough the three surgical procedures are safe and feasible surgical options for FAP, TPC-SIAA plus pedicled omental transposition is more consistent with intestinal physiology, with good intestinal compliance, and anal function tended to be as expected over time. Nevertheless, more extensive studies are needed to confirm these benefits.
Highlights
Familial adenomatous polyposis (FAP) is an autosomal dominant hereditary disease of the rectum and colon involving hundreds to thousands of adenomatous polyps and extracolonic manifestations characteristics [1, 2]
Qin et al World Journal of Surgical Oncology (2022) 20:20 anal function tended to be as expected over time
Patients who received a total proctocolectomy with permanent ileostomy were excluded
Summary
Familial adenomatous polyposis (FAP) is an autosomal dominant hereditary disease of the rectum and colon involving hundreds to thousands of adenomatous polyps and extracolonic manifestations characteristics [1, 2]. The incidence of FAP is approximately 1/8300, accounting for approximately 1% of all colorectal cancers. Monitoring and treatment of FAP have become a major focus and difficulty in gastrointestinal disease diagnosis and treatment worldwide [5]. Popular surgical procedures for FAP include total proctocolectomy with permanent ileostomy (TPC-PI) [6], total colectomy with ileorectal anastomosis (TC-IRA) [7], total proctocolectomy with ileal pouch-anal anastomosis (TPC-IPAA) [8], and total proctocolectomy with straight ileoanal anastomosis (TPC-SIAA) [9, 10]. The decision and timing of FAP surgery have not been standardized, and the choice of surgical method remains a balance between postoperative anal function and radical cure. Optimizing surgical procedures to improve the long-term bowel function postoperatively of FAP patients is a major goal [11]
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