P581 Bleeding after side-to-side isoperistaltic strictureplasty for Crohn’s disease: Is it still a major surgical complication?
F. Giudici*1, S. Scaringi1, F. Ficari1, D. Zambonin1, C. Di Martino1, M. Fazi1, F. Tonelli2, P. Bechi1
1Careggi University Hospital, Surgery and Translational Medicine, Florence, Italy, 2University of Florence, Florence, Italy
Side-to-side isoperistaltic strictureplasty (SSIS) is useful in patients undergoing surgery for Crohn’s disease (CD) to avoid wide small bowel resections. With this technique, a suture can be performed on diseased bowel, thus theoretically increasing the risk of postoperative complications such as bleeding. However, no definitive data regarding postoperative complications have been reported. Our purpose is to evaluate the results obtained in a monocentric population of CD patients who have undergone SSIS.
From 1996 to 2015, 95 CD patients, median age 37 years, underwent SSIS at our centre. SSIS was according Michelassi’s technique in 69 patients; Tonelli’s in 22 patients; and according a new technique in 4 patients. Short-term postoperative complications were recorded.
None of the 95 patients died during surgery, but 25 (26.3%) experienced postoperative complications: 5 patients (5.26%) suffered from an enterorrhagia between the second and eight postoperative days treated with medical therapy; 1 developed a hematoma in the rectal abdominal muscles that was drained percutaneously. In total, 6 patients needed 1 or more blood transfusions because of serious anaemia during the postoperative period and 1 during surgery. Only 1 patient had anastomotic leakage of the SSIS. Two other patients had a leakage of an associated re-strictureplasty (Heineke–Mikulicz). One patient had a pelvic abscess treated with CT-guided drainage. Further, 10 patients had a blood stream infection from the central line catheter; 3 patients developed suppuration of the surgical wound; and 2 had prolonged postoperative paralytic ileum. The median postoperative stay was 11 days (range 7–87).
SSIS seems a safe surgical option because a relatively low rate of global postoperative complications was found. In particular, bleeding inside the bowel lumen is possible but rare. Medical therapy is very effective and should always be considered first for the treatment of such life-threatening complications.