Familial Adenomatous Polyposis

Treatment

The best defense against the development or progression of FAP-related cancer is surgery, either to remove the entire colon (total colectomy), the colon and rectum (proctocolectomy), or sometimes the colon, rectum and part or all of the anus. At Mayo Clinic, physicians usually recommend prophylactic total colectomy when patients are in their late teens or early 20s.

Mayo Clinic surgeons perform the majority of colorectal surgeries using minimally invasive (laparoscopic) techniques. Mayo surgeons been leaders in developing and using laparoscopic surgery for nearly two decades and the clinic is internationally recognized as one of the world's foremost centers for the procedure.

Unlike traditional open surgery, which uses a long abdominal incision, laparoscopic surgery is performed through several small incisions that require just a stitch or two to close. The long-term outcomes for laparoscopic and open surgery are similar, but laparoscopic surgery offers important benefits to patients, including less post-operative pain, a shorter hospital stay and a faster overall recovery.

Surgery doesn't cure FAP. Polyps can continue to form in the remaining or reconstructed portions of your colon as well as in your stomach and small intestine. But with careful monitoring throughout life, these polyps usually can be found and removed in the earliest stages.

Total colectomy

Total colectomy involves removing the entire colon, while preserving your rectum and anus. During the procedure, your surgeon connects the lower end of the small intestine to the top of the rectum, allowing you to have normal bowel movements. Mayo Clinic surgeons almost always perform colectomies through small incisions so you have less scarring and postoperative pain and a faster recovery. But because polyps or cancer can still develop in your rectum, you need careful, lifelong monitoring.

Ileoanal pouch surgery

Ileoanal pouch surgery (also called ileal pouch-anal anastomosis or restorative proctolectomy) is a technically demanding surgical procedure that allows you to have normal bowel movements when both the colon and rectum are removed. Since 1981, Mayo Clinic surgeons have performed more than 3,000 ileoanal pouch procedures, more than any medical center in the world.

During the surgery, your surgeon constructs a pouch, which serves as a reservoir for stool, from the end of your small intestine. The pouch is then attached directly to the anus. To allow time for the pouch to heal, your surgeon creates an ileostomy — a temporary opening in the front of your abdomen for waste. The ileostomy is reversed a few months later in a second, less complex operation. You can then have bowel movements normally, though they will be more watery and more frequent than usual.

In most cases, ileoanal pouch surgery can be performed laparoscopically, which means a smaller incision, less discomfort after the surgery and a shorter hospital stay — usually three to five days rather than seven to 10 days with traditional open surgery.

Although people who undergo ileoanal pouch surgery can live a perfectly normal life, the surgery may affect fertility. For this reason, and because FAP is hereditary, Mayo Clinic provides a team of experts, including a colorectal surgeon, medical geneticist and reproductive gynecologist to help prospective parents consider their options.

Total proctolectomy with ileostomy

Mayo Clinic surgeons recommend the ileoanal pouch procedure for the vast majority of patients. But occasionally, when the anus as well as the colon and rectum must be removed, Mayo surgeons perform an ileostomy, bringing the end of the small bowel to the surface of the abdomen and stitching it permanently in place. The contents of the bowel then enter a bag that's worn on the abdomen. Because adjusting to life with an ileostomy can be physically and emotionally challenging, every ostomy patient at Mayo Clinic receives education, care and support from experienced wound/ostomy/continence nurses.