Laparoscopic Total Proctocolectomy with Ileal pouch-anal Anastomosis for Patients of Familial Adenomatous Polyposis with or without Coexisting Colorectal Cancer

ABSTRACT

PURPOSE: Familial adenomatous polyposis (FAP) normally appears in the early twenties and needs a restorative total proctocolectomy with ileal pouch-anal anastomosis (TPC/ IPAA). Thus, most patients with FAP are young, in socially active stage, and very concerned about their body image. Vast experience with laparoscopic colorectal surgery led us to perform laparoscopic-assissted TPC/IPAA for patients with FAP with or without cancer, and we evaluated the results from technical and oncologic aspects. METHODS: Seventeen of 20 FAP patients underwent laparoscopic- assisted surgery between July 1996 and June 2004. All procedures were done in a totally laparoscopic, a laparoscopic-assisted, or a hand-assisted laparoscopic fashion. RESULTS: Fifteen patients underwent laparoscopic-assisted TCP/IPAA; two others had a total colectomy with ileorectal anastomosis and a TCP with permanent ileostomy laparoscopically. Eight patients showed coexisting colorectal cancers. The mean operation time was 396.5 min. Patients passed flatus or liquid at the 2.2 post-operative day (POD), resumed meals at the 4th. POD, and were discharged at the 10th. POD. There were no intra-operative complications or open conversions. Post-operative complications occurred in 5 different patients. One patient with colon cancer had multiple hepatic metastases at 11 months after the operation and died at 24 months after the operation. CONCLUSIONS: Laparoscopic-assisted surgery for the patients with FAP was technically feasible and could be an alternative method. The systematized and experienced approach could reduce a operation time to be acceptable. In selected cases and with a vast of experience, coexisting colorectal cancer would not be contraindicated for laparoscopic approach for the treatment of FAP.