Functional and long-term outcomes of ileorectal versus ileal pouch–anal anastomosis for familial adenomatous polyposis: a systematic review and meta-analysis

Abstract

Background Colectomy with ileorectal anastomosis (IRA) or proctocolectomy with ileal pouch–anal anastomosis (IPAA) are the 2 standard prophylactic surgical options for patients with familial adenomatous polyposis (FAP). We aimed to compare the functional and long-term outcomes of IRA and IPAA among FAP patients.

Methods We searched large databases to identify studies evaluating the functional outcomes of prophylactic surgical modalities for FAP. The primary outcomes of interest were the functional outcomes of IRA with IPAA, including fecal incontinence, fecal urgency, use of pads for defecation, and use of antidiarrheal drugs. Secondary outcomes included the social outcomes of the 2 procedural modalities, early postoperative adverse events, and long-term adverse events.

Results Compared with IPAA, FAP patients who underwent IRA had a lower frequency of fecal incontinence (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.41-0.76; P<0.001), but were more likely to have fecal urgency (OR 1.53, 95%CI 1.08-2.15; P=0.02). There was no difference in the use of pads and antidiarrheals between the 2 groups (OR 0.55, 95%CI 0.27-1.11; P=0.09; and OR 0.83, 95%CI 0.57-1.22; P=0.35, respectively). Moreover, there was no difference in social outcomes or perioperative adverse events (OR 1.19, 95%CI 0.53-2.68; P=0.68; and OR 0.73, 95%CI 0.50-1.06; P=0.10, respectively). Lastly, IRA had lower long-term complications than IPAA (OR 0.78, 95%CI 0.63-0.97; P=0.03).

Conclusion IRA has better functional outcomes regarding fecal incontinence, a better prophylactic intervention profile, and fewer long-term complications.

Keywords Familial adenomatous polyposis, adenomatous polyposis coli gene, ileorectal anastomosis, ileal pouch–anal anastomosis, meta-analysis

Ann Gastroenterol 2026; 39 (5): 588-596