An international, multicenter, prospective, observational study of the side-to-side isoperistaltic strictureplasty in Crohn's disease

Fabrizio Michelassi, Angelo Taschieri, Francesco Tonelli, Iwao Sasaki, Gilberto Poggioli, Victor Fazio, Gaurav Upadhyay, Roger Hurst, Gianluca M. Sampietro, Marilena Fazi, Yuji Funayama, Filippo Pierangeli

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54 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)277-284
Number of pages8
JournalDiseases of the Colon and Rectum
Volume50
Issue number3
DOIs
Publication statusPublished - 2007 Mar

Keywords

  • Bowel-sparing technique
  • Crohn's disease
  • Side-to-side strictureplasty
  • Strictureplasty

ASJC Scopus subject areas

  • Gastroenterology

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