Diseases of the Colon & Rectum

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Diseases of the Colon & Rectum:
doi: 10.1007/s10350-006-0804-y
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An International, Multicenter, Prospective, Observational Study of the Side-to-Side Isoperistaltic Strictureplasty in Crohn's Disease.

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

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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.

(C) The ASCRS 2007


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