Implications of Bariatric Surgery in Patients with Familial Adenomatous Polyposis Requiring Proctocolectomy with Ileal P
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LETTER TO THE EDITOR
Implications of Bariatric Surgery in Patients with Familial Adenomatous Polyposis Requiring Proctocolectomy with Ileal Pouch Anal Anastomosis Jesus Bollo 1 & Sunaymi Sarria 2 & Carmen Martinez 1 & Teresa Ramon y Cajal 3 & Pilar Hernandez 1 & Elena Carrillo 4 & David Sacoto 1 & Jose Carlos Castillo 1 & Anna Sanchez 1 & Sonia Fernandez- Ananin 5 & Carmen Balague 5 & Eduardo Targarona 1,5
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Dear Editor Familial adenomatous polyposis (FAP) is an autosomal dominant inherited syndrome with high penetrance, caused by a germline mutation in the APC tumor suppressor gene. People with FAP develop hundreds of colorectal polyps that eventually progress to a carcinoma of classic onset in 95– 100% of cases. The average age of onset of FAP is between the second and third decades of life. Treatment is mainly surgical. Indications for surgery are progression (an increase in the number and size of polyps), adenomas with high-grade dysplasia, and severe symptoms or colorectal cancer. Surgery traditionally consists of a total colectomy or a restorative proctocolectomy (RPC) with ileal pouch anal anastomosis (IPAA), sometimes combined with a protective lateral ileostomy [1]. Other features of FAP are thyroid tumors, duodenal tumors, osteomas, hepatoblastomas, adrenal adenomas, and desmoid tumors. Desmoid tumors are also known as fibromatosis masses. They are often found in the muscle but are especially common in the abdominal cavity in the ileal
* Jesus Bollo [email protected] 1
Colorectal Surgery Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
2
Digestive Surgery Department, Hospital General Docente Agostinho Neto, Guantánamo, Cuba
3
Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
4
Pediatrics Department, Hospital Vall d Hebron, Barcelona, Spain
5
Bariatric Surgery Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
mesentery and the jejunal mesentery. A high percentage of these patients develop ampullary and duodenal polyps. The surgical approach in patients with FAP and morbid obesity is complex. RPC-IPAA in a patient with morbid obesity is technically challenging, further increasing morbidity and prolonging surgical time [2, 3]. In view of these issues, bariatric surgery may be considered in selected patients as bridge treatment to subsequent definite colon surgery. It is important to select the most suitable therapeutic option for weight loss because malabsorptive techniques may cause complications during RPC-IPAA, while restrictive approaches such as sleeve gastrectomy (SG) would not.
Clinical Case Here, we present the case of a female patient in whom a mutation of the APC gene was detected following genetic testing at age 13 for a family history of FAP. At age 25, she was referred to our department for morbid obesity and FAP. She weighed 152 kg and had a body mass index of 59.37. In view of the need for prophylactic surgery for th
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