Table 5.

Surgical Options for Polyposis Syndromes

Procedure	Indications
aFAP, attenuated familial adenomatous polyposis; FAP, familial adenomatous polyposis; MAP, MYH associated polyposis; APC, adenomatous polyposis coli.
Abdominal colectomy with ileorectostomy	aFAP by family history, clinical exam, or genetic testing; mild disease (FAP or MAP) as manifested by fewer than 20 polyps in the rectum and less than 1000 overall
Proctocolectomy with ileal-pouch anal anastomosis	Severe disease (FAP or MAP) by family history, clinical exam, or genetic test results; cancer in the colon or mid-upper rectum; risk of desmoid tumor by personal or family history or APC mutation between codons 1403–1578.
Proctocolectomy with ileostomy	When ileal-pouch anal anastomosis contraindicated because of anal sphincter dysfunction or technical problems; low rectal cancer which precludes sphincter preservation.