Side-to-side isoperistaltic strictureplasty in extensive Crohn's disease -A prospective longitudinal study

Objective To report on the results of a prospective longitudinal study of a new bowel-sparing procedure (side-to-side isoperistaltic strictureplasty [ SSIS]) in patients with extensive Crohn's disease. Methods Between January 1992 and April 1999, the authors operated on 469 co nsecutive patients for Crohn's disease of the small bowel. Seventy-one pati ents (15.1%) underwent at least one strictureplasty; of these, 21 (4.5%; 12 men, 9 women: mean age 39) underwent an SSIS. The long-term changes occurr ing in the SSIS were studied radiographically, endoscopically, and histo pa thologically, Results The indication for surgical intervention was symptomatic partial in testinal obstruction in each of the 21 patients. Fourteen SSISs were constr ucted in the jejunum, four in the ileum, and three with ileum overlapping c olon. The average length of the SSIS was 24 cm. Performance of an SSIS inst ead of a resection resulted in preservation of an average of 17% of small b owel length. One patient suffered a postoperative gastrointestinal hemorrha ge. Aii patients were discharged on oral feedings after a mean of 8 days. I n all cases, SSIS resulted in resolution of the preoperative symptoms. With follow-up ex tending to 7.5 years in 20 patients (one patient died of unre lated causes), radiographic, endoscopic, and histopathologic examination of the SSIS suggests regression of previously active Crohn's disease. Conclusions SSIS is a safe and effective procedure in patients with extensi ve Crohn's disease. The authors' results provide radiographic, endoscopic, and histopathologic evidence that active Crohn's disease regresses at the s ite of the SSIS.