Meta-analysis of observational studies of ileorectal versus ileal pouch-anal anastomosis for familial adenomatous polyposis

O Aziz, T Athanasiou, V W Fazio, R J Nicholls, A W Darzi, J Church, R K S Phillips, P P Tekkis

Research output: Contribution to journalReview articlepeer-review


BACKGROUND: Surgery for familial adenomatous polyposis (FAP) aims to minimize cancer risk while providing good functional outcome. Colectomy with ileorectal anastomosis and proctocolectomy with ileal pouch-anal anastomosis both offer this, but there is no clear consensus about which is better.

METHODS: This is a meta-analysis of comparative studies published between 1991 and 2003 reporting early and late postoperative adverse events, functional outcomes and quality of life.

RESULTS: Twelve studies containing 1002 patients (53.4 per cent ileal pouch, 46.6 per cent ileorectal anastomosis) were identified. Bowel frequency (weighted mean difference 1.62 (95 per cent confidence interval (c.i.) 1.05 to 2.20)), night defaecation (odds ratio (OR) 6.64 (95 per cent c.i. 2.99 to 14.74)) and use of incontinence pads (OR 2.72 (95 per cent c.i. 1.02 to 7.23)) were significantly less in the ileorectal group, although faecal urgency was reduced with the ileal pouch (odds ratio 0.43 (95 per cent c.i. 0.23 to 0.80)). Reoperation within 30 days was more common after ileal pouch construction (23.4 versus 11.6 per cent; OR 2.11 (95 per cent c.i. 1.21 to 3.70)). There was no significant difference between the techniques in terms of sexual dysfunction, dietary restriction, or postoperative complications. Rectal cancer was a diagnosis only in the ileorectal group (5.5 per cent).

CONCLUSION: Ileal pouch and ileorectal anastomoses have individual merits. Further research is needed to determine which most benefits patients with FAP.

Original languageEnglish
Pages (from-to)407-17
Number of pages11
JournalThe British Journal of Surgery
Issue number4
Publication statusPublished - Apr 2006


  • Adenomatous Polyposis Coli/surgery
  • Anastomosis, Surgical
  • Colonic Pouches
  • Follow-Up Studies
  • Humans
  • Postoperative Complications/etiology
  • Proctocolectomy, Restorative/methods
  • Publication Bias
  • Quality of Life
  • Reoperation/statistics & numerical data
  • Treatment Outcome

Research Beacons, Institutes and Platforms

  • Manchester Cancer Research Centre


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