To improve the quality of life of patients suffered from familial adenomatous polyposis (FAP), we modify the preventive surgical method.

A retrospective analysis was performed on patients with FAP in Jiangsu Cancer Hospital from June 2019 to March 2020, of which natural orifice specimen extraction surgery (NOSES) was conducted. During the operation, the whole colorectal mesentery was dissociated, the rectum was freed and cut to the plane of the levator ANI. We insert the protective cover and pull out the whole large intestine and rectum through the end of the rectum. We cut the intestine 5 cm away from the ileocecal region and put the anvil at the end of the ileum. Then we reverse the rectum to treat the rectal polyps. At last, we do the end-to-end anastomosis. We collect and analyze the data of gender, height, weight, tumor markers, postoperative ventilation time, defecation situation at the first month, the third month and the sixth month after surgery.

Four patients were received modified NOSES successfully, laparoscopic resection of the colorectum. All patients recover successfully, without anastomotic leakage and massive bleeding and other big postoperative complications. No postoperative abdominal cavity infections were found. The distance from the anastomosis to the anus was negatively associated with the frequency of defection, especially at night.

The modified NOSES follows the aseptic and tumor-free principle. No major complications were found in our cases. The defecation function was improved significantly. Still, large-scale studies were needed in the future.