Primary and secondary restorative proctocolectomy for familial adenomatous polyposis: complications and long-term bowel function

TY - JOUR

T1 - Primary and secondary restorative proctocolectomy for familial adenomatous polyposis

T2 - complications and long-term bowel function

AU - Bülow, S

AU - Højen, Helle

AU - Buntzen, Steen

AU - Larsen, Karen Lindorf

AU - Preisler, Louise

AU - Qvist, Niels

PY - 2013/4

Y1 - 2013/4

N2 - 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 1month 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.

AB - 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 1month 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.

U2 - 10.1111/codi.12020

DO - 10.1111/codi.12020

M3 - Journal article

C2 - 22958269

SN - 1462-8910

VL - 15

SP - 436

EP - 441

JO - Colorectal Disease

JF - Colorectal Disease

IS - 4

ER -