African Journal of Medicine and Surgery

African Journal of Medicine and Surgery ISSN 2756-3324 Vol. 8 (2), pp. 001-006, February, 2021. © International Scholars Journals

Full Length Research Paper

Surgical management of familial adenomatous polyposis in pediatric patients through ileoneorectal anastomosis

Pedro Luiz Toledo de Arruda Lourenção*, Amanda André Monteiro, Marcos Curcio Angelini, Rozemeire Garcia Marques, Antônio Marcos Rodrigues and Erika V. Paiva Ortolan

Discipline of Pediatric Surgery, Surgery Department, Botucatu Medical School, UNESP Univ Estadual Paulista.

Accepted 26 April, 2020

Abstract

Van Laarhoven et al. proposed restorative proctocolectomy with ileoneorectal anastomosis (INRA) to treat familial adenomatous polyposis (FAP). Although it is considered a reproducible surgical technique with low complication rates, there have been few reports of its use in the literature, with no reports addressing pediatric patients. Our pediatric surgery group has been using this technique since 2005. The aim of this study was to analyze the clinical and functional results obtained from the use of this technique to treat children with FAP. Clinical data were retrieved from the children’s medical records. The patients were interviewed regarding their medical conditions, and they received a physical examination to assess their clinical condition, defecation patterns and aspects related to quality of life. Eight patients with a diagnosis of FAP underwent surgical treatment with INRA. The average age was 12.25 (± 2.9) years. The median operative time was 465 minutes, and times ranged from 240 minutes to 600 minutes. There were no intraoperative complications. Three patients required reoperation (2 by flanges and 1 by twisting of the protective ileostomy). The median follow-up time was 36 months (5–120 months). Most patients (57%) presented with regular bowel movements, soft stools and a stool frequency of up to 5 times per day. Two patients had soiling (1 case with daily losses and 1 case with weekly losses). Total proctocolectomy with INRA proved to be a safe and effective technique for the treatment of children with FAP, and it offered satisfactory clinical results.

Keywords: familial adenomatous polyposis; children; surgery; restorative proctocolectomy; ileoneorectal anastomosis.