Correlation between the Severity of Adhesions and Desmoid Disease in Patients with Familial Adenomatous Polyposis: A Prospective Cohort Study.

BACKGROUND: Clinical experience teaches that intraperitoneal adhesions are more severe in patients with familial adenomatous polyposis than in patients without it. This impression may come from the common association of familial adenomatous polyposis with desmoid disease.

OBJECTIVES: To determine whether patients with familial adenomatous polyposis and desmoid disease develop more severe adhesions than those without desmoid disease.

DESIGN: Prospectively collected data study.

SETTINGS: Hereditary colorectal cancer center in a tertiary referral hospital.

PATIENTS: Patients undergoing first reoperative intra-abdominal surgery for familial adenomatous polyposis: controls were those having their initial abdominal surgery.

INTERVENTIONS: Surgery and adhesiolysis.

MAIN OUTCOME MEASURES: Presence and type of desmoid disease; presence and severity of non-desmoid intraperitoneal adhesions. Where patients had multiple operations, only the first reoperative surgery was chosen. Desmoid disease was noted as reaction (sheet) or mass. Adhesions were graded as none, mild (<10 minutes for mobilization), average (10 to 30 minutes) and severe (>30 minutes or significant bowel damage). Patients having first abdominal surgery for familial adenomatous polyposis were used as a control group.

RESULTS: A total of 221 patients had no prior surgery: 5% had desmoids and 1% had adhesions. 137 patients underwent reoperative surgery: 39% had desmoid disease (p < 0.05 vs no prior surgery), the highest rate being in patients after ileal pouch anal anastomosis (57%), and 45% had severe adhesions (p < 0.01 vs no prior surgery), worst after Koch pouch (89%) and total proctocolectomy with ileostomy (82%). 36% of patients without desmoid disease had severe adhesions. Desmoid reaction was associated with severe adhesions in 47% of cases, and desmoid tumors were associated with severe adhesions in 66% of cases.

LIMITATIONS: Possible limitations include the potential overlap between desmoid adhesions and non-desmoid adhesions as well as the potential for inaccuracy in defining time of adhesiolyses.

CONCLUSION: Familial adenomatous polyposis is associated with severe postoperative adhesions after reoperative abdominal surgery, especially in patients who develop desmoid disease.