Current Approaches to Pediatric Polyposis Syndromes

Abstract

Colorectal adenomatous polyposis syndromes encompass a diverse group of disorders with varying modes of inheritance and penetrance. Children may present with overt disease or within screening programs for families at high risk. We provide an overview of the array of pediatric polyposis syndromes, current screening recommendations, and surgical indications and technical considerations. Optimal disease management for these pediatric patients is still evolving and has implications for screening, surveillance, pediatric surgical management, and transition of care gastroenterologic neoplasia physicians and surgeons.

Keywords

IPAA - pediatric polyposis - restorative proctocolectomy

• References

• 1 Burn J, Chapman P, Delhanty J. , et al. The UK Northern region genetic register for familial adenomatous polyposis coli: use of age of onset, congenital hypertrophy of the retinal pigment epithelium, and DNA markers in risk calculations. J Med Genet 1991; 28 (05) 289-296
• 2 Kerr SE, Thomas CB, Thibodeau SN, Ferber MJ, Halling KC. APC germline mutations in individuals being evaluated for familial adenomatous polyposis: a review of the Mayo Clinic experience with 1591 consecutive tests. J Mol Diagn 2013; 15 (01) 31-43
• 3 Bussey H. Familial Polyposis Coli: Family Studies, Histopathology, Differential Diagnosis, and Results of Treatment. Baltimore, MD: Johns Hopkins University Press; 1975
• 4 Vasen HF, Möslein G, Alonso A. , et al. Guidelines for the clinical management of familial adenomatous polyposis (FAP). Gut 2008; 57 (05) 704-713
• 5 Burt RW, Leppert MF, Slattery ML. , et al. Genetic testing and phenotype in a large kindred with attenuated familial adenomatous polyposis. Gastroenterology 2004; 127 (02) 444-451
• 6 Buecher B. Colorectal adenomatous polyposis syndromes: genetic determinism, clinical presentation and recommendations for care. Bull Cancer 2016; 103 (02) 199-209
• 7 Palles C, Cazier JB, Howarth KM. , et al; CORGI Consortium; WGS500 Consortium. Germline mutations affecting the proofreading domains of POLE and POLD1 predispose to colorectal adenomas and carcinomas. Nat Genet 2013; 45 (02) 136-144
• 8 Bellido F, Pineda M, Aiza G. , et al. POLE and POLD1 mutations in 529 kindred with familial colorectal cancer and/or polyposis: review of reported cases and recommendations for genetic testing and surveillance. Genet Med 2016; 18 (04) 325-332
• 9 Spier I, Drichel D, Kerick M. , et al. Low-level APC mutational mosaicism is the underlying cause in a substantial fraction of unexplained colorectal adenomatous polyposis cases. J Med Genet 2016; 53 (03) 172-179
• 10 Chubb D, Broderick P, Frampton M. , et al. Genetic diagnosis of high-penetrance susceptibility for colorectal cancer (CRC) is achievable for a high proportion of familial CRC by exome sequencing. J Clin Oncol 2015; 33 (05) 426-432
• 11 Tomlinson IP, Houlston RS. Peutz-Jeghers syndrome. J Med Genet 1997; 34 (12) 1007-1011
• 12 McGrath DR, Spigelman AD. Preventive measures in Peutz-Jeghers syndrome. Fam Cancer 2001; 1 (02) 121-125
• 13 Hearle N, Schumacher V, Menko FH. , et al. Frequency and spectrum of cancers in the Peutz-Jeghers syndrome. Clin Cancer Res 2006; 12 (10) 3209-3215
• 14 Wirtzfeld DA, Petrelli NJ, Rodriguez-Bigas MA. Hamartomatous polyposis syndromes: molecular genetics, neoplastic risk, and surveillance recommendations. Ann Surg Oncol 2001; 8 (04) 319-327
• 15 Chow E, Macrae F. A review of juvenile polyposis syndrome. J Gastroenterol Hepatol 2005; 20 (11) 1634-1640
• 16 Schreibman IR, Baker M, Amos C, McGarrity TJ. The hamartomatous polyposis syndromes: a clinical and molecular review. Am J Gastroenterol 2005; 100 (02) 476-490
• 17 Cichy W, Klincewicz B, Plawski A. Juvenile polyposis syndrome. Arch Med Sci 2014; 10 (03) 570-577
• 18 Syngal S, Brand RE, Church JM, Giardiello FM, Hampel HL, Burt RW. ; American College of Gastroenterology. ACG clinical guideline: genetic testing and management of hereditary gastrointestinal cancer syndromes. Am J Gastroenterol 2015; 110 (02) 223-262 , quiz 263
• 19 Ngeow J, Mester J, Rybicki LA, Ni Y, Milas M, Eng C. Incidence and clinical characteristics of thyroid cancer in prospective series of individuals with Cowden and Cowden-like syndrome characterized by germline PTEN, SDH, or KLLN alterations. J Clin Endocrinol Metab 2011; 96 (12) E2063-E2071
• 20 Omundsen M, Lam FF. The other colonic polyposis syndromes. ANZ J Surg 2012; 82 (10) 675-681
• 21 Tan MH, Mester JL, Ngeow J, Rybicki LA, Orloff MS, Eng C. Lifetime cancer risks in individuals with germline PTEN mutations. Clin Cancer Res 2012; 18 (02) 400-407
• 22 Nieuwenhuis MH, Kets CM, Murphy-Ryan M. , et al. Is colorectal surveillance indicated in patients with PTEN mutations?. Colorectal Dis 2012; 14 (09) e562-e566
• 23 Snover DC, Ahnen DJ, Burt RW. , et al. Serrated polyps of the colon and rectum and serrated polyposis. In: Bosman T, Carneiro F, Hruban R. , et al. eds. WHO Classification of Tumours of the Digestive System. Lyon: 2010: 160-165
• 24 IJspeert JE, Rana SA, Atkinson NS. , et al; Dutch Workgroup Serrated Polyps & Polyposis (WASP). Clinical risk factors of colorectal cancer in patients with serrated polyposis syndrome: a multicentre cohort analysis. Gut 2017; 66 (02) 278-284
• 25 Kennedy RD, Potter DD, Moir CR, El-Youssef M. The natural history of familial adenomatous polyposis syndrome: a 24 year review of a single center experience in screening, diagnosis, and outcomes. J Pediatr Surg 2014; 49 (01) 82-86
• 26 Kartheuser A, Stangherlin P, Brandt D, Remue C, Sempoux C. Restorative proctocolectomy and ileal pouch-anal anastomosis for familial adenomatous polyposis revisited. Fam Cancer 2006; 5 (03) 241-260 , discussion 261–262
• 27 Ooi BS, Remzi FH, Gramlich T, Church JM, Preen M, Fazio VW. Anal transitional zone cancer after restorative proctocolectomy and ileoanal anastomosis in familial adenomatous polyposis: report of two cases. Dis Colon Rectum 2003; 46 (10) 1418-1423 , discussion 1422–1423
• 28 Giardiello FM, Trimbath JD. Peutz-Jeghers syndrome and management recommendations. Clin Gastroenterol Hepatol 2006; 4 (04) 408-415
• 29 Oncel M, Church JM, Remzi FH, Fazio VW. Colonic surgery in patients with juvenile polyposis syndrome: a case series. Dis Colon Rectum 2005; 48 (01) 49-55 , discussion 55–56
• 30 Young JP, Parry S. Risk factors: hyperplastic polyposis syndrome and risk of colorectal cancer. Nat Rev Gastroenterol Hepatol 2010; 7 (11) 594-595
• 31 Church J, Burke C, McGannon E, Pastean O, Clark B. Risk of rectal cancer in patients after colectomy and ileorectal anastomosis for familial adenomatous polyposis: a function of available surgical options. Dis Colon Rectum 2003; 46 (09) 1175-1181
• 32 Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. BMJ 1978; 2 (6130): 85-88
• 33 Larson DW, Cima RR, Dozois EJ. , et al. Safety, feasibility, and short-term outcomes of laparoscopic ileal-pouch-anal anastomosis: a single institutional case-matched experience. Ann Surg 2006; 243 (05) 667-670 , discussion 670–672
• 34 Fraser JD, Garey CL, Laituri CA, Sharp RJ, Ostlie DJ, St Peter SD. Outcomes of laparoscopic and open total colectomy in the pediatric population. J Laparoendosc Adv Surg Tech A 2010; 20 (07) 659-660
• 35 Potter DD, Tung J, Faubion Jr WA, Moir C. Single-incision laparoscopic colon and rectal surgery for pediatric inflammatory bowel disease and polyposis syndromes. J Laparoendosc Adv Surg Tech A 2012; 22 (02) 203-207
• 36 Schlager A, Siddharthan RV, Santore MT, Balci O, Clifton MS, Heiss KF. Single-incision total proctocolectomy and ileal pouch anal anastomosis in pediatric patients: lessons learned. J Laparoendosc Adv Surg Tech A 2015; 25 (09) 782-785
• 37 Aziz O, Athanasiou T, Fazio VW. , et al. Meta-analysis of observational studies of ileorectal versus ileal pouch-anal anastomosis for familial adenomatous polyposis. Br J Surg 2006; 93 (04) 407-417
• 38 Bülow C, Vasen H, Järvinen H, Björk J, Bisgaard ML, Bülow S. Ileorectal anastomosis is appropriate for a subset of patients with familial adenomatous polyposis. Gastroenterology 2000; 119 (06) 1454-1460
• 39 DeCosse JJ. Surgical prophylaxis of familial colon cancer: prevention of death from familial colorectal cancer. J Natl Cancer Inst Monogr 1995; (17) 31-32
• 40 Smith JC, Schäffer MW, Ballard BR. , et al. Adenocarcinomas after prophylactic surgery for familial adenomatous polyposis. J Cancer Ther 2013; 4 (01) 260-270
• 41 von Roon AC, Tekkis PP, Lovegrove RE, Neale KF, Phillips RK, Clark SK. Comparison of outcomes of ileal pouch-anal anastomosis for familial adenomatous polyposis with and without previous ileorectal anastomosis. Br J Surg 2008; 95 (04) 494-498
• 42 von Roon AC, Will OC, Man RF. , et al. Mucosectomy with handsewn anastomosis reduces the risk of adenoma formation in the anorectal segment after restorative proctocolectomy for familial adenomatous polyposis. Ann Surg 2011; 253 (02) 314-317
• 43 Remzi FH, Church JM, Bast J. , et al. Mucosectomy vs. stapled ileal pouch-anal anastomosis in patients with familial adenomatous polyposis: functional outcome and neoplasia control. Dis Colon Rectum 2001; 44 (11) 1590-1596
• 44 Chambers WM, McC Mortensen NJ. Should ileal pouch-anal anastomosis include mucosectomy?. Colorectal Dis 2007; 9 (05) 384-392
• 45 M'Koma AE, Moses HL, Adunyah SE. Inflammatory bowel disease-associated colorectal cancer: proctocolectomy and mucosectomy do not necessarily eliminate pouch-related cancer incidences. Int J Colorectal Dis 2011; 26 (05) 533-552
• 46 Nugent KP, Phillips RK. Rectal cancer risk in older patients with familial adenomatous polyposis and an ileorectal anastomosis: a cause for concern. Br J Surg 1992; 79 (11) 1204-1206
• 47 Harnoy Y, Desfourneaux V, Bouguen G. , et al. Sexuality and fertility outcomes after hand sewn versus stapled ileal pouch anal anastomosis for ulcerative colitis. J Surg Res 2016; 200 (01) 66-72
• 48 van Balkom KA, Beld MP, Visschers RG, van Gemert WG, Breukink SO. Long-term results after restorative proctocolectomy with ileal pouch-anal anastomosis at a young age. Dis Colon Rectum 2012; 55 (09) 939-947
• 49 Booij KA, Mathus-Vliegen EM, Taminiau JA. , et al. Evaluation of 28 years of surgical treatment of children and young adults with familial adenomatous polyposis. J Pediatr Surg 2010; 45 (03) 525-532
• 50 van Duijvendijk P, Slors JF, Taat CW, Oosterveld P, Vasen HF. Functional outcome after colectomy and ileorectal anastomosis compared with proctocolectomy and ileal pouch-anal anastomosis in familial adenomatous polyposis. Ann Surg 1999; 230 (05) 648-654
• 51 Bartels SA, DʼHoore A, Cuesta MA, Bensdorp AJ, Lucas C, Bemelman WA. Significantly increased pregnancy rates after laparoscopic restorative proctocolectomy: a cross-sectional study. Ann Surg 2012; 256 (06) 1045-1048
• 52 Beyer-Berjot L, Maggiori L, Birnbaum D, Lefevre JH, Berdah S, Panis Y. A total laparoscopic approach reduces the infertility rate after ileal pouch-anal anastomosis: a 2-center study. Ann Surg 2013; 258 (02) 275-282
• 53 Coran AG. A personal experience with 100 consecutive total colectomies and straight ileoanal endorectal pull-throughs for benign disease of the colon and rectum in children and adults. Ann Surg 1990; 212 (03) 242-247 , discussion 247–248
• 54 Rintala RJ, Lindahl H. Restorative proctocolectomy for ulcerative colitis in children--is the J-pouch better than straight pull-through?. J Pediatr Surg 1996; 31 (04) 530-533
• 55 Seetharamaiah R, West BT, Ignash SJ. , et al. Outcomes in pediatric patients undergoing straight vs J pouch ileoanal anastomosis: a multicenter analysis. J Pediatr Surg 2009; 44 (07) 1410-1417
• 56 Wu XR, Kirat HT, Kalady MF, Church JM. ; Wu XR1. Restorative proctocolectomy with a handsewn IPAA: S-pouch or J-pouch?. Dis Colon Rectum 2015; 58 (02) 205-213
• 57 Fonkalsrud EW, Bustorff-Silva J. Reconstruction for chronic dysfunction of ileoanal pouches. Ann Surg 1999; 229 (02) 197-204
• 58 Fujita S, Kusunoki M, Shoji Y, Owada T, Utsunomiya J. Quality of life after total proctocolectomy and ileal J-pouch-anal anastomosis. Dis Colon Rectum 1992; 35 (11) 1030-1039
• 59 Tilney HS, Constantinides V, Ioannides AS, Tekkis PP, Darzi AW, Haddad MJ. Pouch-anal anastomosis vs straight ileoanal anastomosis in pediatric patients: a meta-analysis. J Pediatr Surg 2006; 41 (11) 1799-1808
• 60 Lovegrove RE, Heriot AG, Constantinides V. , et al. Meta-analysis of short-term and long-term outcomes of J, W and S ileal reservoirs for restorative proctocolectomy. Colorectal Dis 2007; 9 (04) 310-320
• 61 McHugh SM, Diamant NE, McLeod R, Cohen Z. S-pouches vs. J-pouches. A comparison of functional outcomes. Dis Colon Rectum 1987; 30 (09) 671-677
• 62 Tuckson WB, Fazio VW. Functional comparison between double and triple ileal loop pouches. Dis Colon Rectum 1991; 34 (01) 17-21
• 63 Gemlo BT, Belmonte C, Wiltz O, Madoff RD. Functional assessment of ileal pouch-anal anastomotic techniques. Am J Surg 1995; 169 (01) 137-141 , discussion 141–142
• 64 Geiger JD, Teitelbaum DH, Hirschl RB, Coran AG. A new operative technique for restorative proctocolectomy: the endorectal pull-through combined with a double-stapled ileo-anal anastomosis. Surgery 2003; 134 (03) 492-495
• 65 Kirat HT, Remzi FH, Kiran RP, Fazio VW. Comparison of outcomes after hand-sewn versus stapled ileal pouch-anal anastomosis in 3,109 patients. Surgery 2009; 146 (04) 723-729 , discussion 729–730
• 66 Ziv Y, Fazio VW, Church JM, Lavery IC, King TM, Ambrosetti P. Stapled ileal pouch anal anastomoses are safer than handsewn anastomoses in patients with ulcerative colitis. Am J Surg 1996; 171 (03) 320-323
• 67 Ganschow P, Warth R, Hinz U, Büchler MW, Kadmon M. Early postoperative complications after stapled vs handsewn restorative proctocolectomy with ileal pouch-anal anastomosis in 148 patients with familial adenomatous polyposis coli: a matched-pair analysis. Colorectal Dis 2014; 16 (02) 116-122
• 68 McIntyre PB, Pemberton JH, Beart Jr RW, Devine RM, Nivatvongs S. Double-stapled vs. handsewn ileal pouch-anal anastomosis in patients with chronic ulcerative colitis. Dis Colon Rectum 1994; 37 (05) 430-433
• 69 Schluender SJ, Mei L, Yang H, Fleshner PR. Can a meta-analysis answer the question: is mucosectomy and handsewn or double-stapled anastomosis better in ileal pouch-anal anastomosis?. Am Surg 2006; 72 (10) 912-916
• 70 Farouk R, Pemberton JH, Wolff BG, Dozois RR, Browning S, Larson D. Functional outcomes after ileal pouch-anal anastomosis for chronic ulcerative colitis. Ann Surg 2000; 231 (06) 919-926
• 71 Ryan DP, Doody DP. Restorative proctocolectomy with and without protective ileostomy in a pediatric population. J Pediatr Surg 2011; 46 (01) 200-203
• 72 Martin LW, LeCoultre C, Schubert WK. Total colectomy and mucosal proctectomy with preservation of continence in ulcerative colitis. Ann Surg 1977; 186 (04) 477-480
• 73 Hahnloser D, Pemberton JH, Wolff BG, Larson DR, Crownhart BS, Dozois RR. Results at up to 20 years after ileal pouch-anal anastomosis for chronic ulcerative colitis. Br J Surg 2007; 94 (03) 333-340
• 74 de Montbrun SL, Johnson PM. Proximal diversion at the time of ileal pouch-anal anastomosis for ulcerative colitis: current practices of North American colorectal surgeons. Dis Colon Rectum 2009; 52 (06) 1178-1183
• 75 Galandiuk S, Scott NA, Dozois RR. , et al. Ileal pouch-anal anastomosis. Reoperation for pouch-related complications. Ann Surg 1990; 212 (04) 446-452 , discussion 452–454
• 76 Baixauli J, Delaney CP, Wu JS, Remzi FH, Lavery IC, Fazio VW. Functional outcome and quality of life after repeat ileal pouch-anal anastomosis for complications of ileoanal surgery. Dis Colon Rectum 2004; 47 (01) 2-11
• 77 Lillehei CW, Leichtner A, Bousvaros A, Shamberger RC. Restorative proctocolectomy and ileal pouch-anal anastomosis in children. Dis Colon Rectum 2009; 52 (09) 1645-1649
• 78 Sugerman HJ, Sugerman EL, Meador JG, Newsome Jr HH, Kellum Jr JM, DeMaria EJ. Ileal pouch anal anastomosis without ileal diversion. Ann Surg 2000; 232 (04) 530-541
• 79 Heuschen UA, Hinz U, Allemeyer EH. , et al. Risk factors for ileoanal J pouch-related septic complications in ulcerative colitis and familial adenomatous polyposis. Ann Surg 2002; 235 (02) 207-216
• 80 Burnstein MJ, Schoetz Jr DJ, Coller JA, Veidenheimer MC. Technique of mesenteric lengthening in ileal reservoir-anal anastomosis. Dis Colon Rectum 1987; 30 (11) 863-866
• 81 Smith L, Friend WG, Medwell SJ. The superior mesenteric artery. The critical factor in the pouch pull-through procedure. Dis Colon Rectum 1984; 27 (11) 741-744
• 82 Martel P, Blanc P, Bothereau H, Malafosse M, Gallot D. Comparative anatomical study of division of the ileocolic pedicle or the superior mesenteric pedicle for mesenteric lengthening. Br J Surg 2002; 89 (06) 775-778
• 83 Martel P, Majery N, Savigny B, Sezeur A, Gallot D, Malafosse M. Mesenteric lengthening in ileoanal pouch anastomosis for ulcerative colitis: Is high division of the superior mesenteric pedicle a safe procedure?. Dis Colon Rectum 1998; 41 (07) 862-866 , discussion 866–867
• 84 Goes RN, Nguyen P, Huang D, Beart Jr RWJ. Lengthening of the mesentery using the marginal vascular arcade of the right colon as the blood supply to the ileal pouch. Dis Colon Rectum 1995; 38 (08) 893-895
• 85 Cherqui D, Valleur P, Perniceni T, Hautefeuille P. Inferior reach of ileal reservoir in ileoanal anastomosis. Experimental anatomic and angiographic study. Dis Colon Rectum 1987; 30 (05) 365-371
• 86 Chu DI, Tognelli J, Kartheuser AH, Dozois EJ. Strategy for the difficult-to-reach ileal pouch-anal anastomosis: technical steps of an in vivo application of a mesenteric-lengthening technique. Tech Coloproctol 2015; 19 (11) 705-709
• 87 Garrard CL, Clements RH, Nanney L, Davidson JM, Richards WO. Adhesion formation is reduced after laparoscopic surgery. Surg Endosc 1999; 13 (01) 10-13
• 88 Linden BC, Bairdain S, Zurakowski D, Shamberger RC, Lillehei CW. Comparison of laparoscopic-assisted and open total proctocolectomy and ileal pouch anal anastomosis in children and adolescents. J Pediatr Surg 2013; 48 (07) 1546-1550
• 89 Causey MW, Stoddard D, Johnson EK. , et al. Laparoscopy impacts outcomes favorably following colectomy for ulcerative colitis: a critical analysis of the ACS-NSQIP database. Surg Endosc 2013; 27 (02) 603-609
• 90 Penna C, Tiret E, Daude F, Parc R. Results of ileal J-pouch-anal anastomosis in familial adenomatous polyposis complicated by rectal carcinoma. Dis Colon Rectum 1994; 37 (02) 157-160
• 91 Barton JG, Paden MA, Lane M, Postier RG. Comparison of postoperative outcomes in ulcerative colitis and familial polyposis patients after ileoanal pouch operations. Am J Surg 2001; 182 (06) 616-620
• 92 Salemans JM, Nagengast FM, Lubbers EJ, Kuijpers JH. Postoperative and long-term results of ileal pouch-anal anastomosis for ulcerative colitis and familial polyposis coli. Dig Dis Sci 1992; 37 (12) 1882-1889
• 93 Prudhomme M, Dozois RR, Godlewski G, Mathison S, Fabbro-Peray P. Anal canal strictures after ileal pouch-anal anastomosis. Dis Colon Rectum 2003; 46 (01) 20-23
• 94 Dayton MT. Redo ileal pouch-anal anastomosis for malfunctioning pouches-acceptable alternative to permanent ileostomy?. Am J Surg 2000; 180 (06) 561-564 , discussion 565
• 95 MacLean AR, Cohen Z, MacRae HM. , et al. Risk of small bowel obstruction after the ileal pouch-anal anastomosis. Ann Surg 2002; 235 (02) 200-206
• 96 Kmiot WA, Williams MR, Keighley MR. Pouchitis following colectomy and ileal reservoir construction for familial adenomatous polyposis. Br J Surg 1990; 77 (11) 1283
• 97 Stavlo PL, Libsch KD, Rodeberg DA, Moir CR. Pediatric ileal pouch-anal anastomosis: functional outcomes and quality of life. J Pediatr Surg 2003; 38 (06) 935-939
• 98 Penna C, Tiret E, Kartheuser A, Hannoun L, Nordlinger B, Parc R. Function of ileal J pouch-anal anastomosis in patients with familial adenomatous polyposis. Br J Surg 1993; 80 (06) 765-767
• 99 Coffey JC, Winter DC, Neary P, Murphy A, Redmond HP, Kirwan WO. Quality of life after ileal pouch-anal anastomosis: an evaluation of diet and other factors using the Cleveland Global Quality of Life instrument. Dis Colon Rectum 2002; 45 (01) 30-38
• 100 Robb B, Pritts T, Gang G. , et al. Quality of life in patients undergoing ileal pouch-anal anastomosis at the University of Cincinnati. Am J Surg 2002; 183 (04) 353-360
• 101 Fazio VW, O'Riordain MG, Lavery IC. , et al. Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 1999; 230 (04) 575-584 , discussion 584–586
• 102 Olsen KØ, Joelsson M, Laurberg S, Oresland T. Fertility after ileal pouch-anal anastomosis in women with ulcerative colitis. Br J Surg 1999; 86 (04) 493-495
• 103 Olsen KØ, Juul S, Bülow S. , et al. Female fecundity before and after operation for familial adenomatous polyposis. Br J Surg 2003; 90 (02) 227-231
• 104 Nelson H, Dozois RR, Kelly KA, Malkasian GD, Wolff BG, Ilstrup DM. The effect of pregnancy and delivery on the ileal pouch-anal anastomosis functions. Dis Colon Rectum 1989; 32 (05) 384-388
• 105 Counihan TC, Roberts PL, Schoetz Jr DJ, Coller JA, Murray JJ, Veidenheimer MC. Fertility and sexual and gynecologic function after ileal pouch-anal anastomosis. Dis Colon Rectum 1994; 37 (11) 1126-1129
• 106 Colwell JC, Gray M. What functional outcomes and complications should be taught to the patient with ulcerative colitis or familial adenomatous polyposis who undergoes ileal pouch anal anastomosis?. J Wound Ostomy Continence Nurs 2001; 28 (04) 184-189
• 107 Vrijland WW, Jeekel J, van Geldorp HJ, Swank DJ, Bonjer HJ. Abdominal adhesions: intestinal obstruction, pain, and infertility. Surg Endosc 2003; 17 (07) 1017-1022
• 108 Milingos S, Kallipolitis G, Loutradis D. , et al. Adhesions: laparoscopic surgery versus laparotomy. Ann N Y Acad Sci 2000; 900: 272-285
• 109 Asztély M, Palmblad S, Wikland M, Hultén L. Radiological study of changes in the pelvis in women following proctocolectomy. Int J Colorectal Dis 1991; 6 (02) 103-107
• 110 Oresland T, Palmblad S, Ellström M, Berndtsson I, Crona N, Hultén L. Gynaecological and sexual function related to anatomical changes in the female pelvis after restorative proctocolectomy. Int J Colorectal Dis 1994; 9 (02) 77-81
• 111 Juhasz ES, Fozard B, Dozois RR, Ilstrup DM, Nelson H. Ileal pouch-anal anastomosis function following childbirth. An extended evaluation. Dis Colon Rectum 1995; 38 (02) 159-165
• 112 Metcalf AM, Dozois RR, Kelly KA. Sexual function in women after proctocolectomy. Ann Surg 1986; 204 (06) 624-627
• 113 Nyam DC, Brillant PT, Dozois RR, Kelly KA, Pemberton JH, Wolff BG. Ileal pouch-anal canal anastomosis for familial adenomatous polyposis: early and late results. Ann Surg 1997; 226 (04) 514-519 , discussion 519–521
• 114 Kartheuser AH, Parc R, Penna CP. , et al. Ileal pouch-anal anastomosis as the first choice operation in patients with familial adenomatous polyposis: a ten-year experience. Surgery 1996; 119 (06) 615-623