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Primary and secondary restorative proctocolectomy for familial adenomatous polyposis: complications and long‐term bowel function
Author(s) -
Bülow S.,
Højen H.,
Buntzen S.,
Larsen K. L.,
Preisler L.,
Qvist N.
Publication year - 2013
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12020
Subject(s) - medicine , proctocolectomy , pouch , familial adenomatous polyposis , anastomosis , surgery , colectomy , bowel function , ulcerative colitis , colorectal cancer , disease , cancer
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.