title: Modified Side-To-Side Isoperistaltic Strictureplasty over the Ileocaecal Valve: An Alternative to Ileocaecal Resection in Extensive Terminal Ileal Crohn's Disease.
abstract: BACKGROUND
  A modified Michelassi strictureplasty over the ileocaecal valve or ileocolic anastomosis could be an alternative to ileocaecal resection. This study assessed the outcome of the modified Michelassi strictureplasty in patients with extensive stenotic terminal ileal Crohn's disease [CD].
  
  
  METHODS
  This type of strictureplasty was proposed to all patients with an extensive strictured [neo-] terminal ileal segment [> 20 cm]. Short- and long-term outcome data were retrieved from a prospectively maintained database. Safety and medium-term efficacy were studied, using both postoperative magnetic resonance enterography [MRE] and ileocolonoscopy at 6 months.
  
  
  RESULTS
  Between June 2009 and September 2014, 29 CD patients had a modified strictureplasty [male 9/29, median age 38 [range: 16-64] years]. The median length of strictureplasty was 50 [27-110] cm. Twelve patients underwent a total of 30 additional procedures during surgery, mainly additional short strictureplasties, but also segmental resections. The majority had a laparoscopic-assisted procedure. Median length of hospital stay was 9 [6-17] days. Two patients had an early rescue procedure to oversew a small anastomotic leak. MRE and ileocolonoscopy at follow-up showed a remarkable regression of inflammation and bowel wall thickness. Clinical recurrence, necessitating initiation or modification of medical therapy, and surgical recurrence were reported in 11 and 1 patient after a median follow-up of 21 [1-54] months, respectively.
  
  
  CONCLUSIONS
  A modified long Michelassi strictureplasty appears to be safe in patients with extensive stricturing Crohn's ileitis. Significant mucosal and bowel wall healing is observed and suggests that clearance of microbial stasis may play a role in this process.
authors.affiliation: University Hospitals Leuven, Department of Abdominal Surgery, KU Leuven, Belgium anthony.debuckvanoverstraeten@uzleuven.be.
authors.forename: A
authors.initials: A
authors.lastname: de Buck van Overstraeten
authors.affiliation: University Hospitals Leuven, Department of Gastroenterology, KU Leuven, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Vermeire
authors.affiliation: University Hospitals Leuven, Department of Radiology, KU Leuven, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Vanbeckevoort
authors.affiliation: Hospital Clinic de Barcelona, Department of Radiology, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Rimola
authors.affiliation: University Hospitals Leuven, Department of Gastroenterology, KU Leuven, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Ferrante
authors.affiliation: University Hospitals Leuven, Department of Gastroenterology, KU Leuven, Belgium.
authors.forename: G
authors.initials: G
authors.lastname: Van Assche
authors.affiliation: University Hospitals Leuven, Department of Abdominal Surgery, KU Leuven, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Wolthuis
authors.affiliation: University Hospitals Leuven, Department of Abdominal Surgery, KU Leuven, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: D'Hoore
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D002432:Cecum / Q000000981:diagnostic imaging / Q000601:surgery*; D056631:Colony Collapse; D003424:Crohn Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D007080:Ileocecal Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D007082:Ileum / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D055815:Young Adult
keywords: Crohn’s disease; Strictureplasty; terminal ileum