Patients with familial adenomatous polyposis have an increased risk of desmoid illness, which may be fatal. Desmoid illness of the abdomen is a common complication of a complete proctocolectomy with IPAA or a total abdominal colectomy with ileorectal anastomosis. Although risk variables such as sex, extraintestinal symptoms, and 3′-mutation location have been found, nothing is known about surgical risk factors. Researchers anticipated that the increased stretch of the small-bowel mesentery caused by pouch creation increases the chance of desmoid formation. The purpose of this research was to identify surgical procedures associated with an increased risk of desmoid development. This research was done between 1995 and 2015 at a single university with a prospectively maintained hereditary colorectal cancer database. A total of 345 patients with familial polyposis who satisfied inclusion criteria and had either proctocolectomy with a pouch or colectomy with an ileorectal anastomosis were chosen. The onset of abdominal desmoid disease symptoms was the major end goal. Desmoid production was studied to see whether there were any correlations between the resection method, the surgical technique used, and the presence of desmoid. There were a total of 173 patients (51%), of whom 172 received proctocolectomy/ileoanal pouch, and a further 173 had complete colectomy/ileorectal anastomosis. About 100 people, or 28.9%, had symptomatic desmoids after surgical removal. Open surgery and pouch surgery, as well as extracolonic symptoms, a family history of desmoids, mutation location, and a high desmoid risk score, were linked with desmoid development in univariate analysis. Multivariate analysis found a significant correlation between desmoid disease and proctocolectomy with pouch (P<0.01). The retrospective design, inconsistent desmoid screening, and varying durations of follow-up hampered these results’ reliability. The severity of polyposis and the number of procedures performed are 2 main confounding variables that have not been accounted for. Compared to patients who received complete colectomy with ileorectal anastomosis for polyposis, those who underwent total proctocolectomy with pouch via any technique had a considerably higher chance of developing the desmoid illness.