Twenty year experience with familial polyposis coli in Cape Town.

Forty-nine patients undergoing surgery for familial polyposis coli (FPC) over a twenty year period are presented. Forty-three patients underwent total colectomy with ileorectal anastomosis (TC + IRA) and five patients subsequently developed a rectal carcinoma. The incidence of rectal carcinoma following TC + IRA appears to increase with time. There were significant postoperative complications secondary to adhesive obstruction and desmoid tumour recurrence. Upper gastrointestinal pathology has been detected by endoscopy in only one of nine patients, but the importance of upper gastrointestinal pathology is now appreciated. The problem of screening a widely distributed and closely knit community has been considerable. TC + IRA remains the operation of choice for the majority of patients with FPC, but a total colectomy with ileal reservoir and ileo-anal anastomosis is appropriate in some cases.