Laparoscopic total proctocolectomy and ileal pouch-anal anastomosis in one or more stages in Familial Adenomatous Polyposis: A single center's experience

Abstract

Introduction

Laparoscopic total proctocolectomy (LTPC) and ileal pouch-anal anastomosis (IPAA) is our first choice for the treatment of Familial Adenomatous Polyposis (FAP). The surgeries were planned in one or multiple stage procedures depending on the clinical condition and intraoperative evaluation of the patient. We present our experience in the last 9 years comparing single and staged procedures.

Methods

The medical records of patients with FAP treated between 2014 and 2023 were analyzed. The surgical indication was agreed upon by an interdisciplinary committee according to the clinical management guidelines for FAP. The surgical technique used had been previously presented. Patients were divided into 3 groups (G) according to the number of surgical stages and compared operative time, initiation of oral feeding, hospital stay, perioperative morbidity and long-term functional outcomes.

Results

19 patients with a mean age of 12.7 years were included: Eight were treated in one stage (G1), 5 in two (G2) and 6 in three or more (G3). Operative time in G1, G2 and G3 was 386.3, 384.6 and 270.5 mins respectively. Initiation of oral feeding was 5.5 days in G1, 5.0 in G2 and 5.5 in G3. The median hospital stay in the first stage was 15.5 days in G1, 8 days in G2 and 22 days in G3. Early complications included anastomotic dehiscence, operative site infection, and intra-abdominal collection, and late complications included intestinal occlusion and anastomotic stricture. The average follow-up was 26 months. All patients are continent. Ten are on a hypofermentative diet and 4 of them use loperamide.

Discussion

LTPC / IPAA is a proven method for the treatment of FAP in the pediatric age, safe and reproducible. Non-significant difference between group 1 and 2 concluded that procedure without protective ileostomy is not associated with greater morbidity. A multidisciplinary team is required as well as advanced laparoscopic training.