P613 Long side-to-side isoperistaltic strictureplasty over the ileocecal valve: a prospective analysis of feasibility and medium term outcome
A. de Buck van Overstraeten*1, S. Vermeire2, G. Van Assche2, D. Vanbeckevoort3, J. Rimola4, M. Ferrante2, A. Wolthuis1, A. D'Hoore1
1University Hospital Gasthuisberg, Department of Abdominal Surgery, Leuven, Belgium, 2University Hospital Gasthuisberg, Division of Gastroenterology, Leuven, Belgium, 3University Hospital Leuven, Department of Radiology, Leuven, Belgium, 4Hospital Clinic de Barcelona, Department of Radiology, Barcelona, Spain
A modified side-to side isoperistaltic strictureplasty over the ileocecal valve could be a valid alternative for ileocecal resection in patients with Crohn's disease (CD) and a long involved ileal segment. We explored the safety and efficacy in a prospective group of patients.
All CD patients with a long stenotic terminal ileum (>25cm) were included. Early ileocolonoscopy and magnetic resonance enterography (MRE) were performed to assess healing. Data were retrieved from a prospectively maintained institutional IBD database.
Between June 2009 and September 2014, 29 patients, with a median age of 38 years (range: 16 - 68) and a median disease duration of 8 years (range: 0 - 34) underwent surgery. Nine male patients were included. Eleven patients were active smokers. Twenty six patients had primary surgery with a strictureplasty over the ileocecal valve. Three patients had a strictureplasty over the ileocolic anastomosis after previous ileocecal resection. Most patients had a laparoscopic approach (n = 24). The median length of the strictureplasty was 50cm (range: 27 - 110). 12 patients had 29 additional procedures: 22 strictureplasties, 6 segmental small bowel resections and 1 reversal of Hartmann's resection. Median length of stay was 9 days (range: 6 - 17) with prolonged postoperative ileus being the main cause of delayed discharge (median: 5 days, range: 2 - 12). Two patients developed a leak requiring additional suturing with successful salvage of the strictureplasty. Twenty-four patients underwent a postoperative colonoscopy at a median follow up of 6 months (range: 2 - 21) with significant improvement of the 'simple endoscopic score in Crohn's disease (SES-CD score). Postoperatieve MRE at a median interval of 6.7 months (range: 2 - 27) showed a significant regression of inflammation, bowel wall thickness and adequate luminal patency. At a median follow up of 10 months (range: 1 - 47), clinical recurrence was reported in 10 patients at a median interval of 14 months (range: 4 - 28). One patient had a surgical recurrence requiring additional strictureplasty after 48 months. Another patient needed adhesiolysis for small bowel obstruction.
A modified long side-to-side isoperistaltic strictureplasty over the ileocecal valve represents a valuable bowel sparing technique in Crohn's disease patients with a long stenotic segment. Surgery is safe and efficient at medium term follow-up.