| How is
FAP treated? |
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There are too many polyps to remove one
by one.
Three types of operation are used: |
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 Colectomy
with ileo rectal anastomosis (IRA) |
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 Total
proctocolectomy with permanent ileostomy |
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 Restorative
proctocolectomy (Pouch) |
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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. |
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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 |
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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. |
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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.
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| Life after the operation |
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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. |
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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. |
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| 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. |
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| 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.
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| Life after the operation |
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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. |
