Increasing numbers of polyposis registries have led to more young patients being diagnosed with
familial adenomatous polyposis (FAP). To provide guidelines for selecting the appropriate
surgical procedure in teenagers (10-19 years), we compared the results of
colectomy and ileo-rectal anastomosis (IRA, n = 17 patients) to the results of
restorative proctocolectomy and
ileal pouch-anal anastomosis (IPAA, n = 7 patients). Charts were reviewed to obtain data on the operative technique, blood loss and transfusions,
hospital stay (including the time for
ileostomy closure), and early (within 30 days of surgery) and late complications. Functional results (bowel movements per 24 h, use of
antidiarrheal drugs, seepage, and
fecal incontinence) and quality of life were evaluated prospectively with a questionnaire and physical examination. The median follow-up time was 49 months (range, 6 to 95 months) after IRA, and 36 months after IPAA (range, 4 to 87 months). Although
restorative proctocolectomy and IPAA, is a longer (5.75 vs 3.1 hours), more bloody (500 vs 300 mL blood loss), and more complex operation with a longer
hospital stay (12 vs 7 days) than IRA (P = 0.008, P = 0.006, P = 0.02, respectively), no significant difference (P > 0.05) was found between groups concerning the complication rate or quality of life. For teenagers with FAP and rectal carpeting, large rectal
adenomas, curable
cancer in the upper two-thirds of the rectum, or who are unavailable for follow-up, we recommend a
restorative proctocolectomy and IPAA. For the other patients, the decision whether to perform IRA or
restorative proctocolectomy with IPAA depends on the patient's desire and the surgeon's skill.