Ileo-anal anastomosis in familial adenomatous polyposis: procedure of choice?

Surgical treatment of familial adenomatous polyposis (FAP) remains controversial. The arguments in favour of ileal pouch-anal anastomosis (IPAA) are well known. All the premalignant mucosa is removed and the risk of rectal carcinoma is avoided. Recent studies have compared results of IPAA and ileo rectal anastomosis (IRA). Morbidity is higher after IPAA, but it does not seem to influence the functional result, and it has to be compared with discomfort of subsequent rectal fulgurations. Functional result of these two procedures is very similar. The risk of occurrence of desmoid tumor is also similar. But desmoid tumor can interfere with the planned treatment and conversion of IRA to IPAA is not always feasible. Furthermore, it is suggested that desmoid tumour could be promoted by iterative surgical trauma. We conclude that it is preferable to perform directly the best and definitive operation and that IPAA is for us the procedure of choice in FAP, except in case of low rectal cancer or extensive colic cancer.