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An International, Multicenter, Prospective, Observational Study of the Side-to-Side Isoperistaltic Strictureplasty in Crohn’s Disease

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Diseases of the Colon & Rectum

Purpose

The side-to-side strictureplasty is a bowel-sparing alternative to resection in the treatment of stricturing Crohn’s disease. This study was initiated to review the adoption of the side-to-side strictureplasty as a new surgical technique and the relative outcomes a decade after its description.

Methods

A total of 184 unique patients from six centers in the United States, Italy, and Japan served as the basis for this study. A questionnaire instrument was used to assemble prospectively acquired preoperative, intraoperative, perioperative, and postoperative data from each center into a computer-generated database.

Results

Average age at surgery for patients selected for a side-to-side strictureplasty varied significantly between centers (minimum, 31.0 years; maximum, 39.5 years, P < 0.006). Use of the side-to-side strictureplasty technique for primary Crohn’s disease vs. surgically recurrent disease also varied significantly by center (primary minimum, 16.7 percent; maximum, 68.6 percent, P < 0.03). Furthermore, length of diseased bowel selected for construction of a side-to-side strictureplasty was significantly different among centers (minimum, 20.8 ± 9.9 cm; maximum, 64.3 ± 29.3 cm, P < 0.001). Use of synchronous bowel resection away from the site of the side-to-side strictureplasty was relatively common (minimum, 21.1 percent; maximum, 66.7 percent) as it was with the use of additional synchronous strictureplasties (minimum, 41.9 percent; maximum, 83.3 percent). The six centers experienced a low number of complications (minimum, 5.7 percent; maximum, 20.8 percent). Forty-one of 184 total patients required surgery for recurrent disease, with an average time to recurrence of 35 months. The difference of reoperation-free five-year survival experienced by the patients in the six centers was not statistically significant, with a cumulative reoperation-free five-year survival of 77 percent across all centers.

Conclusions

Worldwide implementation of the side-to-side strictureplasty technique and its variations has occurred. This procedure carries a very low mortality and morbidity rate, with acceptable recurrence rates.

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Acknowledgments

The authors thank Kristen E. Kasza, M.S., of the University of Chicago Department of Health Studies for statistical analyses and support.

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Authors and Affiliations

  1. Department of Surgery, Weill Medical College, Cornell University, 1300 York Avenue, P.O. Box 129, New York, New York, 10021

    Fabrizio Michelassi M.D.

  2. Dipartimento di Scienza Cliniche “Luigi Sacco,”, Università degli Studi di Milano, Milano, Italy

    Angelo Taschieri M.D. & Gianluca M. Sampietro M.D.

  3. Department of Clinical Physiopathology, University of Florence, Florence, Italy

    Francesco Tonelli M.D.

  4. Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan

    Iwao Sasaki M.D. & Yuji Funayama M.D.

  5. Surgical Unit, Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy

    Gilberto Poggioli M.D. & Filippo Pierangeli M.D.

  6. Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio

    Victor Fazio M.B., M.S.

  7. Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA

    Gaurav Upadhyay B.A. & Roger Hurst M.D.

  8. Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy

    Marilena Fazi M.D.

Authors
  1. Fabrizio Michelassi M.D.
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  2. Angelo Taschieri M.D.
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  3. Francesco Tonelli M.D.
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  4. Iwao Sasaki M.D.
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  5. Gilberto Poggioli M.D.
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  6. Victor Fazio M.B., M.S.
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  7. Gaurav Upadhyay B.A.
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  8. Roger Hurst M.D.
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  9. Gianluca M. Sampietro M.D.
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  10. Marilena Fazi M.D.
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  11. Yuji Funayama M.D.
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  12. Filippo Pierangeli M.D.
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Corresponding author

Correspondence to Fabrizio Michelassi M.D..

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Cite this article

Michelassi, F., Taschieri, A., Tonelli, F. et al. An International, Multicenter, Prospective, Observational Study of the Side-to-Side Isoperistaltic Strictureplasty in Crohn’s Disease. Dis Colon Rectum 50, 277–284 (2007). https://doi.org/10.1007/s10350-006-0804-y

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  • DOI: https://doi.org/10.1007/s10350-006-0804-y

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