Colectomy for familial adenomatous polyposis

FAP is an inherited condition that causes many adenomatous polyps. Surgery is planned according to the number, size and microscopic features of polyps, any cancer findings, symptoms and whether the rectum can be monitored safely.

One approach removes the colon and joins the small bowel to the rectum. Another removes both colon and rectum and creates an internal pouch connected to the anus. In some circumstances, waste leaves through an ileostomy into a bag on the abdomen, either temporarily or long term.

The options differ in bowel frequency, continence, fertility considerations and the need for future surveillance. Keeping the rectum can preserve function but leaves tissue where polyps may continue to form. Removing it changes the operation and recovery.

Before surgery, review medicines, nutrition, previous abdominal operations and family plans with the colorectal team. If an ileostomy is possible, a stoma nurse can mark a suitable site and demonstrate equipment. Follow the hospital's bowel preparation and fasting instructions exactly.

During recovery, gradually increase food and activity as directed, drink enough to replace fluid losses and observe wound or stoma changes. Continued endoscopic checks remain necessary for any rectum or pouch left in place, because new polyps can develop there. FAP follow-up may also include other parts of the digestive tract.

Contact the surgical team urgently for worsening abdominal pain, repeated vomiting, a swollen abdomen, fever, a wound that becomes red or drains pus, or inability to pass stool or gas. With an ileostomy, very high watery output, little or no output with cramps, dizziness or reduced urine also needs prompt assessment.

Call emergency services for severe breathing difficulty, collapse, chest pain or sudden heavy bleeding. These symptoms require immediate care rather than waiting for a routine surgical review.

Ask which operation is recommended and why, whether the rectum will remain, the possibility of an ileostomy and how bowel function may change. Clarify the surveillance plan, genetic support for relatives, fertility considerations, expected dietary adjustments and whom to contact about dehydration or blockage symptoms.