Restorative Procto Colectomy:

In a restorative procto-colectomy the entire colon and most of the rectum is removed. The sphincters and anal canal are preserved. A new rectum (neo rectum) is formed from the ileum by anastamosing the ileum to itself in a J shaped pouch (Parke's J pouch). Usually some of the muscle is left in the distal rectum and the mucosa excised. This pouch is then anastamosed to the sphincters.

Restorative procto-colectomy in this setting is usually done in two stages. In the first operation the colon and rectum are resected, the pouch formed and anastamosed to the sphincters, a temporary diverting loop ileostomy is formed to protect the patient from a major leak from the pouch. In the second operation, the temporaray loop stoma is reversed.

About 20% of people will loose the pouch, due to leaks and pelvic sepsis. Where the pouch is successful, the patient may expect at least 8 bowel motions a day and continence is not perfect.

Satisfaction with the pouch is not as great in patients with FAP as it is in patients who opt for a pouch due to severe ulcerative colitis, this is probably because quality of life in patients with ulcerative colitis is so miserable before the resection and pouch formation while on the whole patients with FAP are well prior to surgery and opt for surgery because of the percieved threat of colo-rectal cancer.

The main advantages of this approach are; elimination of the risk of cancer from the colon and rectum and preservation of the normal route of elimination.

The main disadvantages of this approach are; complex multi-stage surgery, numerous admissions and operations, high risk of failure, high number of bowel motions and less than perfect continence.