Surgery for familial adenomatous polyposis aims to minimize cancer risk while providing good functional outcome.
Colectomy with ileorectal anastomosis and proctocolectomy with ileal pouch-anal anastomosis both offer this, but there is no clear consensus about which is better.
Dr Aziz and colleagues conducted a meta-analysis of comparative studies published between 1991 and 2003.
The researchers considered studies reporting early and late postoperative adverse events, functional outcomes and quality of life.
The researchers 12 identified studies containing 1002 patients, of which 53% had ileal pouch, and 47% had ileorectal anastomosis.
Bowel frequency, night defaecation, and use of incontinence pads were significantly less in the ileorectal group.
The team found that fecal urgency was reduced in patients with ileal pouch.
However, reoperation within 30 days was more common after ileal pouch construction at 23% versus 12% in the ileorectal group.
| Reoperation within 30 days was more common after ileal pouch construction|
|British Journal of Surgery|
There was no significant difference between the techniques in terms of sexual dysfunction, dietary restriction, or postoperative complications.
The researchers noted that rectal cancer was a diagnosis only in the ileorectal group.
Dr Aziz and colleagues concluded, “Ileal pouch and ileorectal anastomoses have individual merits.”
“Further research is needed to determine which most benefits patients with familial adenomatous polyposis.”