Primary and secondary restorative proctocolectomy for familial adenomatous polyposis: complications and long-term bowel function
Article first published online: 27 MAR 2013
© 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland
Volume 15, Issue 4, pages 436–441, April 2013
How to Cite
Bülow, S., Højen, H., Buntzen, S., Larsen, K. L., Preisler, L. and Qvist, N. (2013), Primary and secondary restorative proctocolectomy for familial adenomatous polyposis: complications and long-term bowel function. Colorectal Disease, 15: 436–441. doi: 10.1111/codi.12020
- Issue published online: 27 MAR 2013
- Article first published online: 27 MAR 2013
- Accepted manuscript online: 7 SEP 2012 11:28AM EST
- Received 24 May 2012; accepted 16 July 2012; Accepted Article online 7 September 2012
- Familial adenomatous polyposis;
- restorative proctocolectomy;
- ileoanal pouch
Aim The aim of the study was to evaluate intra-operative difficulties, complications and long-term bowel function in polyposis patients undergoing conversion of an ileorectal anastomosis to an ileoanal pouch, compared with patients with a primary ileoanal pouch operation.
Method A national register-based retrospective study was performed with clinical follow-up and a questionnaire on long-term bowel function.
Results There were 84 patients in the study: 59 (70%) had a primary pouch operation and in 25 (30%) a secondary pouch procedure was attempted. This was abandoned, in one case, leaving 24 patients who had a successful secondary restorative proctocolectomy. The median (range) follow-up was 123 (0–359) months. There were no intra-operative difficulties in the 59 primary operations, but intra-operative difficulties were reported in nine of 25 secondary operations (P < 0.001). Complications within 1 month of surgery occurred in six of 59 primary operations and in none of 24 secondary operations (P < 0.001); and late surgical complications occurred in eight of 55 primary operations and in eight of 24 secondary operations (P = 0.13). The only difference in bowel function was a lower frequency of nocturnal defaecation after secondary pouch formation (P = 0.02).
Conclusion Reoperation with proctectomy after a previous ileorectal anastomosis and conversion to restorative proctocolectomy is feasible in polyposis patients, with morbidity and functional results similar to those seen after a primary pouch operation.