Side-to-side isoperistaltic strictureplasty for multiple Crohn's strictures

Abstract

BACKGROUND: Strictureplasties are being used with increased frequency in the surgical treatment of severe and extensive Crohn's disease of the small bowel; concerns regarding their use have been raised in the presence of long and rigid strictures or when strictures are located in close proximity to each other. METHODS: A new surgical technique, a side-to-side isoperistaltic strictureplasty, has been used in three patients with severe Crohn's disease of the small bowel extending up to three feet in length. RESULTS: Three patients (3 males; mean age, 42 years) had recurrent Crohn's jejunoileitis extending over the length of 22, 37, and 14 inches. This represented 19, 16, and 24 percent, respectively, of the entire length of their small bowel. In the first two patients, resection of 5 and 7 inches, respectively, from the middle third of the diseased segment facilitated performance of the side-to-side isoperistaltic strictureplasty; in the last patient, the procedure was performed after resection of a 57-inch bypassed loop. All patients had an uncomplicated postoperative course and, at a recent follow-up visit between 4 and 24 months, they continue to be asymptomatic and do not require steroid medications. CONCLUSIONS: We believe that the side-to-side isoperistaltic strictureplasty is a useful adjunct to the armamentarium of the surgeon dealing with patients affected by inflammatory bowel disease. With this technique, bowel is not resected, blind or bypassed loops are avoided, and stenoses are palliated.