Side-to-side-to-end strictureplasty for Crohn's disease.
OBJECTIVE
Side-to-side strictureplasty is a useful procedure for preserving the bowel in patients with Crohn's disease. However, bowel resection is required in some patients, and diseased proximal bowel and disease-free distal bowel exist after resection. We performed a modified new technique called side-to-side-to-end strictureplasty.


METHODS
Four patients with Crohn's disease underwent this procedure. After resection of the diseased bowel that was not suitable for strictureplasty, side-to-side strictureplasty was performed with use of the proximal diseased loop. Thereafter, the distal end of the side-to-side stricture was anastomosed to the distal disease-free bowel in a side-to-side-to-end manner.


RESULTS
The length of the small intestine requiring surgical intervention was 69.8 +/- 26.4 (mean +/- standard deviation) cm, and the length of the small intestine necessitating resection was 31.8 +/- 12.6 cm. Side-to-side stricture was performed by use of 48.8 +/- 20.2 cm of the diseased proximal bowel, which was anastomosed to the disease-free distal bowel. Intra-abdominal abscess, which was not associated with this procedure, was observed in one patient, but was treated by drainage. The recoveries of all four patients were uneventful, without recurrence, after a follow-up of 21.5 +/- 16.2 months.


CONCLUSIONS
Side-to-side-to-end strictureplasty may be a useful procedure when diseased proximal bowel and disease-free distal bowel are present after bowel resection in patients with Crohn's disease.
Hotokezaka
Masayuki
M
Department of Surgical Oncology and Regulation of Organ Function, Miyazaki University School of Medicine, Miyazaki 889-1692, Japan.
Ikeda
Takuto
T
Uchiyama
Shuichiro
S
Hayakawa
Shoichiro
S
Tsuchiya
Kazuyo
K
Chijiiwa
Kazuo
K
D000328:Adult; D000714:Anastomosis, Surgical; D003251:Constriction, Pathologic; D003424:Crohn Disease / Q000473:pathology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013536:Suture Techniques; D016896:Treatment Outcome