Short- and long-term outcomes following side-to-side strictureplasty and its modification over the ileocecal valve for extensive Crohn's ileitis.

BACKGROUND AND AIMS Postoperative recurrence remains a challenging problem in patients with Crohn's disease (CD). To avoid development of short-bowel syndrome, strictureplasties techniques have therefore been proposed. We evaluated short and long-term outcomes of atypical strictureplasties in CD patients with extensive bowel involvement. METHODS Side-to-side isoperistaltic strictureplasty (SSIS) was performed according to the Michelassi technique or modification of this over the ileocecal valve (mSSIS). Ninety-day postoperative morbidity was assessed using the comprehensive complication index (CCI). Clinical recurrence was defined as symptomatic endoscopically or radiologically confirmed stricture/inflammatory lesion requiring medical treatment or surgery. Surgical recurrence was defined as the need for any surgical intervention. Endoscopic remission was defined as ≤ i1, according to the modified Rutgeerts score. Deep remission was defined as the combination of endoscopic remission and absence of clinical symptoms. Perioperative factors related to clinical recurrence were evaluated. RESULTS Fifty-two CD patients (SSIS n = 12; mSSIS n= 40) were included. No mortality occurred. Mean CCI was 10.3 (range 0-33.7). Median follow-up was 5.9 years (range 0.8-9.9). Clinical recurrence (19 patients) was 29.7% and 39.6% after 3 and 5 years, respectively. Surgical recurrence (7 patients) was 2% and 14.1% after 3 and 5 years, respectively. At the end of the follow-up, 92% of patients kept the original strictureplasty and deep remission was observed in 25.7% of the mSSIS patients. None of the perioperative variables considered showed a significant association with clinical recurrence. CONCLUSION SSIS is safe, effective and provides durable disease control in patients with extensive CD ileitis.