Modified side-to-side isoperistaltic strictureplasty over the ileocaecal valve for the surgical treatment of terminal ileal Crohn's disease: the ultimate bowel sparing technique?
OBJECTIVE
The study describes the technique of a modified side-to-side isoperistaltic strictureplasty over the ileocaecal valve.


METHODS
The technical details of a modified side-to-side isoperistaltic strictureplasty of the terminal ileum for stricturing Crohn's disease is described including Figs. 1 and 2 and a video illustration (Video S1).


RESULTS
Between November 2010 and December 2015, 36 patients underwent a side-to-side isoperistaltic strictureplasty of the (neo-)terminal ileum (men 14/36; median age 35 years [interquartile range (IQR) 26-51 years]). Thirty were operated by either multiport or single port laparoscopy. The median length of hospital stay was 9 (IQR 8-11) days. Anastomotic leakage occurred in two patients both in the first five cases. In both the anastomosis could be rescued by additional suturing. After a median follow-up of 18.9 (IQR 7.0-36.0) months, 14 patients had developed clinical recurrence and one had a surgical recurrence at 63 months.


CONCLUSIONS
A modified side-to-side isoperistaltic strictureplasty is a feasible and safe technique, rendering maximal bowel sparing surgery possible.
Department of Abdominal Surgery, University Hospital Leuven, KU Leuven, Leuven, Belgium.
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de Buck van Overstraeten
Department of Abdominal Surgery, University Hospital Leuven, KU Leuven, Leuven, Belgium.
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Wolthuis
Department of Abdominal Surgery, University Hospital Leuven, KU Leuven, Leuven, Belgium.
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D'Hoore
D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods*; D057868:Anastomotic Leak / Q000453:epidemiology / Q000601:surgery; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D003424:Crohn Disease / Q000150:complications / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000209:etiology / Q000601:surgery*; D007080:Ileocecal Valve / Q000601:surgery*; D010535:Laparoscopy; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments; D012008:Recurrence; D016896:Treatment Outcome
Crohn's disease; Michelassi; Terminal ileitis; bowel sparing technique; strictureplasty