Outcome of Total Proctocolectomy with Ileal Pouch Anal Anastomosis Using Diverting Loop Ileostomy in Familial Adenomatous Polyposis

Background: Total proctocolectomy with ileal pouch anal anastomosis (IPAA) is a standard procedure for many diseases, including familial adenomatosis polyposis (FAP). This procedure can be achieved by different options. Objectives: To report and assess the outcome of a two-stage operation: Proctocolectomy with IPAA with diverting loop ileostomy followed by ileostomy reversal as a second stage using a stapled technique for J-pouch type. Methods: A prospective study conducted in Basrah Gastroenterology and Hepatology Hospital from March 2022 to June 2025. It involves 10 patients (two males and 8 females) diagnosed as FAP by colonoscopy and histopathological biopsies. All patients experienced two-stage operations. Laparotomies using the stapled technique were performed for all patients. The J-pouch type was created in all of them. Follow-up for all patients was achieved by scheduled visits. Results: No death was reported in this study. In addition, none of the patients developed anastomotic leakage, pouch loss, impotence, pulmonary embolism, bleeding, fecal incontinence, postoperative pneumonia, or intestinal obstruction. However, the following complications were reported as follows: Pouchitis (2/10), incisional hernia (2/10), wound infection (3/10), and peristomal dermatitis (10/10). Conclusions: This operation successfully achieved the primary treatment of FAP without serious complications, such as leakage, which encourages further studies involving larger sample sizes and the use of various staged surgical procedures for FAP or other patients with a broader range of underlying diseases.