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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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