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?

Abstract

The study describes the technique of a modified side-to-side isoperistaltic strictureplasty over the ileocaecal valve. 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). 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 35years [interquartile range (IQR) 26-51years]). 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 63months. A modified side-to-side isoperistaltic strictureplasty is a feasible and safe technique, rendering maximal bowel sparing surgery possible.