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Preventing short bowel in Crohn’s: a novel surgical approach ▸

Extensive fibrostenotic jejunoileal disease presents a particular therapeutic problem in Crohn’s disease. Conventional drug treatment is ineffective and biological agents contraindicated. Surgical resection is clearly possible, but adds the additional risk of leaving the patient with a short bowel. In selected cases, multiple short strictureplasties may be possible, but often the disease is virtually confluent and this approach is impossible. In 1992 Michelassi described an extended side-to-side ileoperistaltic strictureplasty (SSIS) which, as it suggests, allows long segments of disease to be dealt with without resection. In this article, they describe 184 patients with primary and recurrent disease from six centres in Europe and the US who have undergone SSIS. The average length of the diseased segment undergoing strictureplasty was 37.8 cm with a range of 7 to 121.9 cm. Gastrointestinal haemorrhage, leak and obstruction were the common complications and one patient died from a pulmonary embolus. However 89% of operations were complication free. Of the 184 patients, 41 required further surgery for recurrent disease with a mean interval of 35 months, but the cumulative operation free survival at 5 years was 77%. Preservation of bowel length in patients with extensive …

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