A new study recently published in the journal JAMA Surgery reveals that a bowel-sparing surgical option for Crohn’s disease (CD) patients, called side-to-side isoperistaltic strictureplasty (SSIS), can be beneficial — and with acceptable recurrence rates.
The study, “Long-term Results and Recurrence-Related Risk Factors for Crohn’s Disease in Patients Undergoing Side-to-Side Isoperistaltic Strictureplasty,” was conducted by researchers at the University of Florence, Italy.
CD is a type of inflammatory bowel disease (IBD) characterized by chronic inflammation in the gastrointestinal (GI) tract, with the inflammation triggered in any location of the patient’s body, although most commonly in the small bowel.
The condition affects all layers of the gastrointestinal wall (mucosa, sub-mucosa, muscular externa and serosa). Common symptoms include irregular and frequent bowel movements, weight loss, malaise, fatigue, and persistent diarrhea with occasional rectal bleeding. Complications specific to CD include blockage of the intestine due to inflammation and swelling that leads to abdominal cramps, vomiting, and bloating.
In the SSIS surgical procedure, strictures (narrowing of the bowel’s lumen), instead of being removed (called a bowel resection), are widened by making a cut lengthwise along the bowel and then suturing the ends. This surgery restores a free flow through the bowel without removing the narrowed segments, sparing the patient’s bowel.
Researchers believed SSIS could be useful in patients undergoing surgery for CD to avoid wide small-bowel resections, but there were no definitive data regarding its recurrence risk factors.
To answer this question, the team from Italy examined clinical data from a population of 91 CD patients who underwent SSIS in the authors’ center, from August 1996 to March 2010. With mean preoperative disease duration of 97.9 months, the patients (averaging 39.5 years of age) underwent treatment with two different SSIS techniques — 69 patients received treatment according to the Michelassi technique, and 22 patients according to the Tonelli technique.
Based on the follow-up data available for 91.2 percent of the patients, the team found that 44.58 percent experienced recurrence at a mean of 55.46 months after surgery, and that 28.9 percent of the patients experienced recurrence at the SSIS site at a mean of 48.25 months after surgery.
Furthermore, the investigators found that:
- There was a borderline correlation between the patients’ family record of CD and surgical recurrence;
- There was a considerable association for recurrence in the SSIS with the time spent between diagnosis and surgery;
- In multivariate analysis, the independent risk factors for recurrence were smoking habit, age at surgery, age at diagnosis, and family history.
According to a press release, the research team concluded: “In the short-term, SSIS leads to a resolution of symptoms in more than 90 percent of cases and the recurrence rate in the SSIS area is acceptable, even after long-term follow-up.”