How is FAP treated?
There are too many polyps to remove one by one.
Three types of operation are used:
Colectomy with ileo rectal anastomosis (IRA)
Total proctocolectomy with permanent ileostomy
Restorative proctocolectomy (Pouch)
Following an examination the surgeon will discuss with the patient which type of operation should be done. These operations are described in more detail below.
This operation involves removing all of the colon. The end of the small bowel (the ileum) is then joined (anastomosed) to the top of the rectum. That is why it is called an ileorectal anastomosis or IRA for short.

It may be necessary to stay in hospital for 6-8 days. Most people will get back to normal life in about six weeks. Strenuous exercise, such as lifting heavy weights, should perhaps be avoided for about 3 months. Afterwards most people will got to the toilet 3 or 4 times a day and the stools (or faeces) may be softer than before. If a person finds that they need to go more often, tablets called loperamide (Imodium) can be taken. These tablets slow down the bowel and are not addictive.

Life after the operation
Some people find that certain types of food upset their bowel and are best avoided. Others eat whatever they want when they want to. People differ greatly but beer, spicy foods, raw vegetables and fruit are often mentioned as causing loose bowel motions. Each person has to find out what suits them.

Follow up after surgery

People who have had a colectomy with ileorectal anastomosis will still have their rectum. Polyps may continue to develop in the rectum and it is important that the rectum is examined regularly which is done in the outpatient department every six months.

This type of operation is now rarely done for polyposis. It involves removing the whole of the colon, rectum and anus. Because the anus has been removed it is not possible to control the bowel in the usual way.

The end of the small bowel (called the ileum) is brought out onto the abdomen where it protrudes about an inch. This is called an ileostomy. It is stitched into place so there is no need to worry about it falling back inside.

The waste product will come out of the ileostomy into a discrete bag that is securely stuck onto the skin of the abdomen and which is worn under the clothes. With an ileostomy it is not possible to control when it will act but it is possible to control the emptying or changing of the bag. The stoma care nurse will provide support and education.

Life after the operation
After the operation it is usually necessary to stay in hospital for about 2 weeks. Return to normal activities can begin after about 6 to 8 weeks although strenuous activity should be avoided for about 3 months. The majority of individuals with an ileostomy will lead a normal life. Activities such as swimming do not need to be avoided. Some people find it best to avoid certain foods, especially those that are fibrous and pithy (for example, oranges) because they can lead to obstruction of the small bowel.

Follow up after surgery

Once things have settled down it is usual to be seen in the outpatient department on a yearly basis.

This operation involves removing the colon and the rectum, but the anus is left. An artificial rectum, called a pouch, is made out of the lower end of the small intestine (ileum). The pouch is jointed to the anus so bowel actions can be controlled in the normal way. The pouch stores the faeces until the person goes to the lavatory in the usual way. Usually this operation is done in two stages.
Stage 1 The colon and rectum are removed and the pouch is made and joined to the anus. Because the operation is quite complicated, it is sometimes necessary to allow the new pouch time to "rest" while it heals. This is done by creating a temporary ileostomy above the pouch which means that stools have to be collected in a bag which is worn outside the body, on the abdomen (tummy). The bag will need to be emptied at certain times.

The average stay in hospital is around 10-12 days after the operation. Return to light work is usually possible between four to six weeks postoperatively.

Stage 2 After at least 2 months, when the pouch has healed, the ileostomy is closed by a second operation so that stools are again passed from the anus in the usual way.

With this operation the average stay in hospital is a bit shorter (4-6 days).

Sometimes it is possible to do the operation without creating a temporary ileostomy. This should be discussed with the surgeon.

Life after the operation
In the early stages most people pass soft stool. When things have settled down most people find they need to go to the lavatory between 4 and 6 times a day. The stool will be the consistency of porridge. It should be no problem to hold on for a while after feeling the urge to go. Some people need to go at night and few may feel more confident if they wear a small pad in case of any minor leakage. Some people find that certain types of food upset their bowels but they find out which by trial and error. Foods that are fibrous or pithy (for example, oranges) should be eaten with care or avoided as they may lead to the bowel becoming obstructed. If a person’s bowel actions are too frequent they may need to adjust their diet or take tablets such as loperamide (Imodium). These tablets slow down the bowel and are not addictive.

Follow up after surgery

When everything has settled down after the operation, it is usual to return to the outpatient department clinic once a year.

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