Short- and Long-term Outcomes Following Side-to-side Strictureplasty and its Modification Over the Ileocaecal Valve for Extensive Crohn's Ileitis.
J Crohns Colitis
; 14(10): 1378-1384, 2020 Oct 05.
Article
em En
| MEDLINE
| ID: mdl-32227163
ABSTRACT
BACKGROUND AND AIMS:
Postoperative recurrence remains a challenging problem in patients with Crohn's disease [CD]. To avoid development of short bowel syndrome, strictureplasty 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 ileocaecal 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:
A total of 52 CD patients [SSIS nâ =â 12; mSSIS nâ =â 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 [seven 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.CONCLUSIONS:
SSIS is safe, effective, and provides durable disease control in patients with extensive CD ileitis.Palavras-chave
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MEDLINE
Assunto principal:
Complicações Pós-Operatórias
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Procedimentos Cirúrgicos do Sistema Digestório
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Anastomose Cirúrgica
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Doença de Crohn
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Efeitos Adversos de Longa Duração
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Ileíte
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Valva Ileocecal
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article