Mucosectomy vs. stapled ileal pouch - Anal anastomosis in patients with familial adenomatous polyposis functional outcome and neoplasia control

F. H. Remzi*, J. M. Church, J. Bast, I. C. Lavery, S. A. Strong, T. L. Hull, G. J C Harris, C. P. Delaney, M. G. O'Riordain, E. A. McGannon, V. W. Fazio

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

122 Scopus citations

Abstract

PURPOSE: The tradeoff of neoplasia control for better function represented by a stapled ileal pouch-anal anastomosis is still controversial in patients with familial adenomatous polyposis. We compared outcomes after mucosectomy and hand-sewn ileal pouch-anal anastomosis with those after stapled ileal pouch-anal anastomosis in 119 patients with familial adenomatous polyposis who underwent surgery since 1983. METHODS: Age, gender, length of follow-up, complications, quality of life, incontinence, urgency, nighttime and daytime seepage, pad usage, necessity of ileostomy, and incidence of adenomas developing in pouch and anal transitional zone were recorded. RESULTS: There were 42 mucosectomy and 77 stapled patients who were followed up for an average of 5.8 and 3.6 years, respectively, with endoscopic surveillance. There was one postoperative death in the stapled group that prohibited long-term follow up. Nine of 42 mucosectomy patients developed pouch adenomas vs. 8 of 76 in the stapled group. Six of 42 patients developed adenomas in the mucosectomized anal transitional zone in the mucosectomy group. Twenty-one of 76 patients developed adenomas in the anal transitional zone in the stapled group. All were managed with local procedures or further surveillance. One of 76 patients developed cancer in the residual low rectum; this required further resection. Patients with stapled anastomosis had better outcomes in every category. Differences in incontinence, daytime and nighttime seepage, pad usage, and avoidance of ileostomy were statistically significant. All patients with mucosectomy required ileostomy vs. only 40 of 77 patients with stapled anastomosis. CONCLUSION: Familial adenomatous polyposis patients with stapled ileal pouch-anal anastomosis have better functional outcome and can avoid temporary diversion. This should be balanced against a 28 percent incidence of adenomas in the anal transitional zone.

Original languageEnglish (US)
Pages (from-to)1590-1596
Number of pages7
JournalDiseases of the colon and rectum
Volume44
Issue number11
DOIs
StatePublished - Jan 1 2001

Keywords

  • Anal transitional zone
  • Familial adenomatous polyposis
  • Ileal pouch-anal anastomosis
  • Mucosectomy
  • Stapled anastomosis

ASJC Scopus subject areas

  • Gastroenterology

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