**2.1 Familial adenomatous polyposis**

FAP is an inherited disease classically characterized by the development of hundreds to thousands of adenomas in the rectum and colon during the second decade of life (**Figure 1**). A less aggressive variant of FAP is the so-called attenuated FAP (aFAP), where the rectum is frequently spared.

Although FAP is responsible for less than 1% of colorectal malignancies, untreated individuals with FAP carry a 100% risk of colorectal cancer by 40–50 years.

Thus, for patients with FAP, the single way to prevent colorectal cancer is surgery. Nowadays, it is widely accepted that RPC-IPAA is the procedure of choice to treat patients with classical FAP.

We can choose for aFAP, total abdominal colectomy with ileorectal anastomosis (TAC-IRA), or proctocolectomy with stapled ileal pouch distal rectal anastomosis (CP-IPDRA).

FAP highlights:

• young population; absolute indication for surgery; if present rectal involvement, proctocolectomy is required; higher risk of desmoid in some family; RPC-IPAA is the procedure of choice to treat patients with classical FAP; RPC-IPAA easier in FAP than in UC [5].

**Figure 1.** *Familial adenomatous polyposis – colon details.*
