Surgery for Familial Adenomatous Polyposis

The surgical treatment of familial adenomatous polyposis (FAP) is aimed at minimising the risk of colorectal cancer whilst leaving the patient with a good functional outcome and one that is socially acceptable to them [1]. The ideal operation for FAP should therefore be safe with regards to post-operative morbidity and mortality, preserve faecal continence, spare pelvic innervation to the sexual organs, and eliminate cancer risk [2]. Because patients with FAP are generally young and often asymptomatic at the time of presentation for surgery, the prospect of undergoing a "proctocolectomy and end ileostomy" is one they understandably find difficult to accept, making surgical options for FAP that remove the need for a permanent stoma attractive. The two most common options that offer this are the "colectomy and ileo-rectal anastomosis" (IRA) and "procto-colectomy with ileal pouch anal anastomosis" (IPAA), with no clear consensus on which of these two options is the best first-line treatment. This is because surgery that preserves intestinal continuity for FAP involves balancing certain risks and benefits, all of which must be taken into account individually before the final surgical option is decided. These are considered in turn below.

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