Short- and Long-term Outcomes Following Side-to-side Strictureplasty and its Modification Over the Ileocaecal Valve for Extensive Crohn's Ileitis

J Crohns Colitis. 2020 Oct 5;14(10):1378-1384. doi: 10.1093/ecco-jcc/jjaa066.

Abstract

Background and aims: Postoperative recurrence remains a challenging problem in patients with Crohn's disease [CD]. To avoid development of short bowel syndrome, strictureplasty techniques have therefore been proposed. We evaluated short- and long-term outcomes of atypical strictureplasties in CD patients with extensive bowel involvement.

Methods: Side-to-side isoperistaltic strictureplasty [SSIS] was performed according to the Michelassi technique or modification of this over the ileocaecal valve [mSSIS]. Ninety-day postoperative morbidity was assessed using the comprehensive complication index [CCI]. Clinical recurrence was defined as symptomatic, endoscopically or radiologically confirmed, stricture/inflammatory lesion requiring medical treatment or surgery. Surgical recurrence was defined as the need for any surgical intervention. Endoscopic remission was defined as ≤i1, according to the modified Rutgeerts score. Deep remission was defined as the combination of endoscopic remission and absence of clinical symptoms. Perioperative factors related to clinical recurrence were evaluated.

Results: A total of 52 CD patients [SSIS n = 12; mSSIS n = 40] were included. No mortality occurred. Mean CCI was 10.3 [range 0-33.7]. Median follow-up was 5.9 years [range 0.8-9.9]. Clinical recurrence [19 patients] was 29.7% and 39.6% after 3 and 5 years, respectively. Surgical recurrence [seven patients] was 2% and 14.1% after 3 and 5 years, respectively. At the end of the follow-up, 92% of patients kept the original strictureplasty and deep remission was observed in 25.7% of the mSSIS patients. None of the perioperative variables considered showed a significant association with clinical recurrence.

Conclusions: SSIS is safe, effective, and provides durable disease control in patients with extensive CD ileitis.

Keywords: Crohn’s disease; long-term recurrence; strictureplasty; surgery.

MeSH terms

  • Adult
  • Anastomosis, Surgical* / adverse effects
  • Anastomosis, Surgical* / methods
  • Belgium / epidemiology
  • Constriction, Pathologic / etiology
  • Constriction, Pathologic / surgery
  • Crohn Disease* / complications
  • Crohn Disease* / epidemiology
  • Crohn Disease* / physiopathology
  • Crohn Disease* / surgery
  • Digestive System Surgical Procedures* / adverse effects
  • Digestive System Surgical Procedures* / methods
  • Female
  • Humans
  • Ileitis* / etiology
  • Ileitis* / physiopathology
  • Ileitis* / surgery
  • Ileocecal Valve* / pathology
  • Ileocecal Valve* / surgery
  • Long Term Adverse Effects* / diagnosis
  • Long Term Adverse Effects* / physiopathology
  • Long Term Adverse Effects* / surgery
  • Male
  • Outcome and Process Assessment, Health Care
  • Postoperative Complications* / diagnosis
  • Postoperative Complications* / physiopathology
  • Postoperative Complications* / surgery
  • Recurrence
  • Remission Induction / methods
  • Reoperation / methods
  • Reoperation / statistics & numerical data
  • Severity of Illness Index