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{{Familial adenomatous polyposis}}
{{Familial adenomatous polyposis}}


{{CMG}} {{AE}} {{MJK}}
{{CMG}} {{AE}} {{SSH}}, {{MJK}}


==Overview==
==Overview==
Surgery is the mainstay of treatment for familial adenomatous polyposis.
[[Surgery]] is the mainstay of treatment for familial adenomatous polyposis (FAP). The preferred [[surgery]] technique is [[Laparoscopic surgery|laparoscopic]] total [[proctocolectomy]] with ileal pouch anal [[anastomosis]] (IPAA) and mucosectomy. Another technique is total [[colectomy]] with ileorectal [[anastomosis]].
==Indications==
Surgery is recommended in patients with FAP who present with:<ref name="KennedyPotter2014">{{cite journal|last1=Kennedy|first1=Raelene D.|last2=Potter|first2=D. Dean|last3=Moir|first3=Christopher R.|last4=El-Youssef|first4=Mounif|title=The natural history of familial adenomatous polyposis syndrome: A 24year review of a single center experience in screening, diagnosis, and outcomes|journal=Journal of Pediatric Surgery|volume=49|issue=1|year=2014|pages=82–86|issn=00223468|doi=10.1016/j.jpedsurg.2013.09.033}}</ref><ref name="pmid10630758">{{cite journal |vauthors=King JE, Dozois RR, Lindor NM, Ahlquist DA |title=Care of patients and their families with familial adenomatous polyposis |journal=Mayo Clin. Proc. |volume=75 |issue=1 |pages=57–67 |year=2000 |pmid=10630758 |doi=10.4065/75.1.57 |url=}}</ref>
*Diffuse [[Polyp|polyposis]]
*High-grade [[dysplasia]] on [[colonoscopy]]
*Invasive [[adenocarcinoma]] on [[colonoscopy]]
==Surgery==
==Surgery==
* Treatment for FAP depends on the genotype. Most individuals with the APC mutation will develop colon cancer by the age of 40.  
[[Surgery]] is the mainstay of treatment for familial adenomatous polyposis.
* There are several surgical options that involve the removal of either the colon or both the [[colon]] and [[rectum]].
* The preferred surgical technique for FAP is:
* The decision to remove the rectum depends on the number of polyps in the rectum as well as the family history.
** Laparoscopic total proctocolectomy with ileal pouch anal anastomosis (IPAA) and mucosectomy which has:<ref name="KennedyPotter2014">{{cite journal|last1=Kennedy|first1=Raelene D.|last2=Potter|first2=D. Dean|last3=Moir|first3=Christopher R.|last4=El-Youssef|first4=Mounif|title=The natural history of familial adenomatous polyposis syndrome: A 24year review of a single center experience in screening, diagnosis, and outcomes|journal=Journal of Pediatric Surgery|volume=49|issue=1|year=2014|pages=82–86|issn=00223468|doi=10.1016/j.jpedsurg.2013.09.033}}</ref>
* If the rectum has few polyps, the colon is removed and the small bowel ([[ileum]]) is connected to the rectum (ileorectal anastomosis).
*** Good patient satisfaction
* If the rectum is involved then the colon and rectum are removed and the patient may require an [[ileostomy]] or have an ileoanal pouch reconstruction.
*** Excellent functional outcome
 
*** Few postoperative complications
*** No [[Colon (anatomy)|colorectal]] occurrence or recurrence
{{#ev:youtube|bDXsdaZl9hQ}}
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* Other surgical techniques include:
** Total [[colectomy]] with ileorectal [[anastomosis]]
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==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Genetic disorders]]
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[[Category:Surgery]]
 
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Latest revision as of 21:43, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2], Mohamad Alkateb, MBBCh [3]

Overview

Surgery is the mainstay of treatment for familial adenomatous polyposis (FAP). The preferred surgery technique is laparoscopic total proctocolectomy with ileal pouch anal anastomosis (IPAA) and mucosectomy. Another technique is total colectomy with ileorectal anastomosis.

Indications

Surgery is recommended in patients with FAP who present with:[1][2]

Surgery

Surgery is the mainstay of treatment for familial adenomatous polyposis.

  • The preferred surgical technique for FAP is:
    • Laparoscopic total proctocolectomy with ileal pouch anal anastomosis (IPAA) and mucosectomy which has:[1]
      • Good patient satisfaction
      • Excellent functional outcome
      • Few postoperative complications
      • No colorectal occurrence or recurrence

{{#ev:youtube|bDXsdaZl9hQ}} {{#ev:youtube|4l1qS1waolA}}

{{#ev:youtube|nDuKZAibgrc}}

References

  1. 1.0 1.1 Kennedy, Raelene D.; Potter, D. Dean; Moir, Christopher R.; El-Youssef, Mounif (2014). "The natural history of familial adenomatous polyposis syndrome: A 24year review of a single center experience in screening, diagnosis, and outcomes". Journal of Pediatric Surgery. 49 (1): 82–86. doi:10.1016/j.jpedsurg.2013.09.033. ISSN 0022-3468.
  2. King JE, Dozois RR, Lindor NM, Ahlquist DA (2000). "Care of patients and their families with familial adenomatous polyposis". Mayo Clin. Proc. 75 (1): 57–67. doi:10.4065/75.1.57. PMID 10630758.

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