Choice of operation in familial adenomatous polyposis.

There are 3 surgical options for patients who have familial adenomatous polyposis. None of them guarantees a 100% cure of the disease, although they all minimize or eliminate the risk of colorectal cancer. Proctocolectomy with ileostomy is rarely necessary as a procedure of choice. Its only indication would be in patients who have already developed a rectal cancer in the lower third of the rectum. It tends not to be well accepted in asymptomatic patients and acts as a deterrent to family members to even seek help through surveillance. Colectomy with ileorectal anastomosis is a comparatively safe, simple, and uncomplicated procedure with a rapid recovery and a good functional result. It does, however, leave the patient liable for a small risk of rectal cancer, although not a large risk of dying of rectal cancer. Patients who do not do well with ileorectal anastomosis or who subsequently develop large numbers of polyps or even cancer in the upper parts of the rectum at an early stage can still be converted to the third option, which is an ileoanal pouch procedure. Colectomy with rectal mucosectomy and ileoanal pouch procedure with a temporary ileostomy is not, in our view, necessary for all patients with FAP. It is reserved in our practice for patients who present late with large numbers of rectal polyps or for those who desire not to have any risk of rectal cancer and is also used for patients who have had ileorectal anastomosis who develop large numbers of polyps in follow-up surveillance and screening.(ABSTRACT TRUNCATED AT 250 WORDS)