Australian experience of side‐to‐side isoperistaltic stricturoplasty in Crohn's disease

Abstract

Background The Michelassi stricturoplasty has demonstrated efficacy for Crohn's disease in European and American series but has not had uptake in Australia. We report the short‐term results of side‐to‐side isoperistaltic stricturoplasty (SSIS) in an Australian Practice. Methods Between March 2015 and October 2021 SSIS procedures were performed on Crohn's patients with long segment Crohn's strictures associated with obstructive symptoms, despite best medical therapy. Surgical demographics and results were recorded via inpatient and outpatient follow‐up in a prospective database. Results Twenty‐one SSIS performed in 16 patients, nine female, mean age 40 years. Single incision laparoscopic surgery (SILS) was used in 10 patients. The standard Michelassi SSIS used for 11 strictures and a Poggioli variant used for 10. Mean stricture length 32 cm (range 5–100); mean SSIS length 24 cm (range 6–55). Associated bowel resection in seven cases with a mean length of 47 mm. Ten patients had an average of three additional stricturoplasties. Complications included central line sepsis in one, deep surgical site infection in one and superficial wound infection in four patients. Mean duration of operation; 346 min and length of stay 10 days. Conclusion SSIS techniques are safe for the management of long segment stricturing Crohn's disease. Although not widely used in Australia, surgeons should consider the Michelassi stricturoplasty, and its variants, for long Crohn's strictures as they are isoperistaltic whilst avoiding bowel resection and blind pouches.

Proposed clinical operative synoptic report for ileocolic resection for Crohn's disease

“…The study has been limited by the exclusion of cases which involved intestinal-sparing approach (Michelassi-type) for ileocolic CD. 15 A few operative details were understandably not documented such as iatrogenic injury if no event was encountered. This was similar to the Mujukian's study.…”