SURGICAL TREATMENT FOR FAMILIAL ADENOMATOUS POLYPOSIS WITH RECONSTRUCTION OF RECTAL MUCOSA

Objective. To assess long-term outcome of surgical treatment for familial adenomatous polyposis (FAP) with the use of cell transplantation. Material and methods. The study included 57 patients with FAP who underwent restorative proctocolectomy with resection of the rectum and ileal pouch-rectal anastomosis. This surgical method involves preserving the distal part of the rectum. Mucosectomy in a preserved rectum is done. To reconstruct rectal mucosa, cell transplantation is performed with fetal allogenic cells of intestinal epithelium and mesenchyma. After that double stapled anastomosis is formed between ileal pouch and the preserved part of rectum. Results. Four weeks after cell transplantation, rectal mucosa was restored in 75.4% of patients. Early perioperative complications were found in 8.8%, late complications were detected in 11.3% of cases. The endoscopy and pathology performed during a median follow-up of 26 months did not reveal any signs of epithelial dysplasia or adenoma formation in the preserved part of the rectum. Satisfactory quality of life and absence of social isolation were registered in 94% of subjects. Conclusion. Preserving the distal part of the rectum leads to better functional results of restorative proctocolectomy with pouchrectal anastomosis. The allogenic cell transplantation allows to attain reconstruction of the rectal mucosa in a short period after surgery. All patients with FAP require life-long medical follow-up.

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