Symptoms are Common After Total Proctocolectomy With Ileal Pouch Creation in Patients With Familial Adenomatous Polyposis
Douglas K. Rex, MD, MASGE, reviewing Gilad O, et al. Clin Transl Gastroenterol 2020 Oct.
Pouch symptoms are typically considered to occur less frequently after total proctocolectomy and ileal pouch-anal anastomosis (IPAA) for familial adenomatous polyposis (FAP) compared to after IPAA for inflammatory bowel disease.
In a prospective study, 51 patients who underwent IPAA for FAP were followed. Pouch symptoms developed in 39.2% of patients and were less common after single-stage IPAA compared to two-stage IPAA (13.8% vs 42.9% with ≤5 bowel movements per day). Patients who underwent single-stage IPAA also had more solid stools and less abdominal pain. Age <20 years at the time of surgery was associated with fewer daily bowel movements (58% vs 18% with ≤5 bowel movements per day), more solid stools, and less abdominal pain. Endoscopic evidence of inflammation was seen in a third of patients but did not correlate with clinical symptoms.
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COMMENTThis prospective study suggests that the frequency of symptoms after IPAA for FAP is common, but the risk is substantially lower with single-stage IPAA and with surgery at a young age.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Gilad O, Gluck N, Brazowski E, Kariv R, Rosner G, Strul H. Determinants of pouch-related symptoms, a common outcome of patients with adenomatous polyposis undergoing ileoanal pouch surgery. Clin Transl Gastroenterol 2020;11:e00245. (https://doi.org/10.14309/ctg.0000000000000245)