An international, multicenter, prospective, observational study of the side-to-side isoperistaltic strictureplasty in Crohn's disease.
OBJECTIVE
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.
Michelassi
Fabrizio
F
Department of Surgery, Weill Medical College, Cornell University, 1300 York Avenue, P.O. Box 129, New York, New York 10021, USA. fam2006@med.cornell.edu
Taschieri
Angelo
A
Tonelli
Francesco
F
Sasaki
Iwao
I
Poggioli
Gilberto
G
Fazio
Victor
V
Upadhyay
Gaurav
G
Hurst
Roger
R
Sampietro
Gianluca M
GM
Fazi
Marilena
M
Funayama
Yuji
Y
Pierangeli
Filippo
F
D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003424:Crohn Disease / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007558:Italy; D007564:Japan; D008297:Male; D019370:Observation; D011183:Postoperative Complications; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States