Single-stage Laparoscopic Proctocolectomy with Ileal pouch-anal Anastomosis for Familial Adenomatous Polyposis

Purpose: Assess the safety of single-stage laparoscopic proctocolectomy with ileal pouch-anal anastomosis (LPC-IPAA) in children with familial adenomatous polyposis (FAP). Methods: Medical records for all patients with FAP who underwent LPC-IPAA between 1/1/2013 and 8/1/2024 at a pediatric center were reviewed. Baseline characteristics, postoperative complications, and functional outcomes were assessed. Results: Thirty-nine patients met inclusion criteria. Mean age was 14.9 years (range 9.4-21.5) and mean BMI was 23.0 (range 15.3-47.0). Follow-up averaged 2.8 years (SD 2.9). Mean operative time was 228.4 minutes (SD 44.5) in the stapled group (n = 32) and 316.1 minutes (SD 43.1) in the hand-sewn group (n = 7) (p < 0.001). There were no anastomotic leaks. One patient developed a postoperative abscess. Six (15%) developed presumed pouchitis, 4 of whom were in the hand-sewn group and all successfully treated with antibiotics. Six patients (15%) developed an anastomotic stricture – all in the stapled group – and responded well to anal dilation. No patient required treatment for fecal incontinence. Conclusion: LPC-IPAA in adolescents and young adults with FAP can safely be performed in a single operation and is associated with favorable functional outcomes.