# Laparoscopic restorative proctocolectomy with transanal total mesorectal excision for familial adenomatous polyposis in a 13-year-old: Case report and review of minimally invasive approaches

## TL;DR

A 13-year-old with a rare genetic condition underwent successful minimally invasive surgery to prevent cancer, showing this approach can work in adolescents.

## Contribution

This is the youngest reported case of TaTME-assisted restorative proctocolectomy for FAP, demonstrating its feasibility in adolescents.

## Key findings

- Laparoscopic restorative proctocolectomy with TaTME was successfully performed in a 13-year-old with FAP.
- Good functional outcomes were achieved at 2-year follow-up with 5–6 bowel movements per day and maintained continence.
- The narrow adolescent pelvis may enhance transanal visualization, potentially benefiting surgical precision.

## Abstract

Familial adenomatous polyposis (FAP) necessitates prophylactic colorectal surgery to prevent inevitable malignant transformation. While transanal approaches have gained acceptance in adult colorectal surgery, their application in pediatric populations remains limited. We present a young case and review current minimally invasive approaches for adolescent FAP management.

A 13-year-old girl with genetically confirmed FAP (APC mutation c.3927_3931delAAAGA) presented with chronic lower gastrointestinal bleeding and iron deficiency anemia. Colonoscopy revealed extensive polyposis with high-grade dysplasia in multiple polyps involving both rectum and sigmoid colon. We performed laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis using transanal total mesorectal excision (TaTME) technique for rectal dissection. Total operative time was 280 min with minimal blood loss. The patient recovered uneventfully and was discharged on postoperative day 7. Diverting ileostomy was reversed at 10 weeks following contrast enema confirmation of intact anastomosis.

To our knowledge, this represents the youngest reported case of TaTME-assisted restorative proctocolectomy for FAP. While the narrow adolescent pelvis poses technical challenges for conventional approaches, it may theoretically enhance transanal visualization during the procedure. At two-year follow-up, the patient demonstrates good functional outcomes with 5–6 bowel movements per 24 h and maintained daytime continence.

Laparoscopic restorative proctocolectomy utilizing TaTME technique appears feasible and safe in carefully selected adolescent FAP patients when performed by experienced teams. This approach may offer advantages for rectal dissection in the confined pediatric pelvis while maintaining excellent functional outcomes. Further studies are needed to validate these findings.

•To our knowledge, youngest reported use of TaTME technique in FAP patient based on systematic literature search•High-grade dysplasia at age 13 necessitated immediate surgical intervention•Narrow adolescent pelvis may enhance visualization during transanal approach•Good functional outcomes achieved at 2-year follow-up•Case demonstrates feasibility when performed by experienced teams with appropriate expertise

To our knowledge, youngest reported use of TaTME technique in FAP patient based on systematic literature search

High-grade dysplasia at age 13 necessitated immediate surgical intervention

Narrow adolescent pelvis may enhance visualization during transanal approach

Good functional outcomes achieved at 2-year follow-up

Case demonstrates feasibility when performed by experienced teams with appropriate expertise