Abstract
Purpose: Strictureplasty has commonly been used for short stenotic tracts, but it has rarely been applied to stenoses longer than 10 cm. Michelassi proposed a side-to-side isoperistaltic strictureplasty for single or multiple strictures that affected long bowel tracts. The experience and results obtained to date with this type of strictureplasty are limited. We therefore decided to review the cases in which we performed this procedure. Methods: Thirty-one patients, aged 21 to 66 years, underwent this operation between August 1996 and October 2002. Indications for surgery included subocclusion in 22 patients, malnutrition in 9 patients, and fistula or abscess in 6 patients. Two side-to-side isoperistaltic strictureplasties have been performed in jejunum, 6 in jejunum-ileum, 16 in the proximal ileum, 1 in terminal ileum, and 6 in the ileo-cecal tract. Results: The average length ofside-to-side isoperistaltic strictureplasty as 32. 1 cm (range, 10–54 cm). Sixteen patients also underwent concomitant bowel resection and 17 patients have received additional strictureplasty. There was no perioperative mortality, nor were there any postoperative complications requiring reoperation. In all patients intestinal occlusion and malnutrition were resolved. Decrease of activity indices was observed in 62. 3 percent of patients within 6 months after surgery. At an average follow-up of 26. 4 months, six patients required reoperation, but in only one of them did the recurrence involve a previous strictureplasty site. In that case the side-to-side isoperistaltic strictureplasty was soft and was without signs of inflammation or stenosis. Conclusions: Side-to-side isoperistaltic strictureplasty seems to provide a technical solution leading to improvement when long intestinal inflamed tract are treated. Longer follow-up and larger experience is needed to validate this observation.
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References
Lee EC, Papaioannou N. Minimal surgery for chronic obstruction in patients with extensive or universal Crohn’s disease. Ann R Coll Surg Engl 1982; 64: 229–33
Katariya RN, Sood S, Rao PG, Rao PL. Stricture-plasty for tubercular strictures of the gastro-intestinal tract. Br J Surg 1977; 64: 496–8
Tonelli F, Ficari F. Stictureplasty in Crohn’s disease: surgical option. Dis Colon Rectum 2000; 43: 920–6
Stebbing JF, Jewell DP, Kettlewell MG, Mortensen NJ. Long-term results of recurrence and reoperation after strictureplasty for obstructive Crohn’s disease. Br J Surg 1995; 82: l471–4
Michelassi F. Side-to-side isoperistaltic strictureplasty for multiple Crohn’s strictures. Dis Colon Rectum 1996; 39: 345–9
Michelassi F, Hurst R, Melis M, et al. Side-to-side isoperistaltic stictureplasty in extensive Crohn’s disease. A prospective longitudinal study. Ann Surg 2000; 232: 401–8
Tjandra JJ, Fazio VW. Strictureplasty for ileocolonic anastomotic strictures in Crohn’s disease. Dis Colon Rectum 1993; 36: 1099–104
Poggioli G, Stocchi L, Laureti S, et al. Conservative surgical management of terminal ileitis: side-to-side enterocolic anastomosis. Dis Colon Rectum 1997; 40: 234–9
Fazio VW, Tjandra JJ. Strictureplasty for Crohn’s disease with multiple long strictures. Dis Colon Rectum 1993; 36: 71–2
Sasaki I, Funayama Y, Naito H, Fukushima K, Shibata C, Matsuno S. Extended strictureplasty for multiple short skipped strictures of Crohn’s disease. Dis Colon Rectum 1996; 39: 342–4
Bijnen AB, Schneve RH, Westbroek DL. Calibration of stenosis of the small intestine with marble. Surg Gynecol Obstet 1987; 164: 175–6
Ozuner G, Fazio VW, Lavery IC, Church JM, Hull TL. How safe is strictureplasty in the management of Crohn’s disease? Am J Surg 1996; 171: 57–61
Tjandra JJ, Fazio VW. Strictureplasty without concomitant resection for small bowel obstruction in Crohn’s disease. Br J Surg 1994; 81: 561–3
Hurst RD, Michelassi F. Strictureplasty for Crohn’s disease: techniques and long term results. World J Surg 1998; 22: 359–63
Taschieri AM, Cristaldi M, Elli M, et al. Description of new “bowel-sparing” techniques for long strictures of Crohn’s disease. Am J Surg 1997; 173: 509–12
Sayfan J, Wilson AL, Allan A, Andrews M, Alexander-Williams J. Recurrence after strictureplasty or resection for Crohn’s disease. Br J Surg 1989; 76: 335–8
Ozuner G, Fazio VW, Lavery IC, Milsom JW, Strong SA. Reoperative rates for Crohn’s disease following strictureplasty: long-term analysis. Dis Colon Rectum 1996; 39: 1199–203
Tonelli F, Ficari F. Pathological features of Crohn’s disease determining perforation. J Clin Gastroenterol 1991; 13: 226–30
Marchetti F, Fazio VW, Ozuner G. Adenocarcinoma arising from a strictureplasty site in Crohn’s disease: report of a case. Dis Colon Rectum 1996; 39: 1315–21
Jaskowiak NT, Michelassi F. Adenocarcinoma at a strictureplasty site in Crohn’s disease: report of a case. Dis Colon Rectum 2001; 44: 284–7
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Tonelli, F., Fedi, M., Paroli, G.M. et al. Indications and results of side-to-side isoperistaltic strictureplasty in Crohn’s disease. Dis Colon Rectum 47, 494–501 (2004). https://doi.org/10.1007/s10350-003-0084-8
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DOI: https://doi.org/10.1007/s10350-003-0084-8