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Side-to-side Strictureplasty for Crohn's Disease

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Preserving Bowel and Quality of Life in Crohn's Disease

Fabrizio Michelassi, MD has pioneered a new bowel-sparing procedure for patients with advanced Crohn's disease called side-to-side isoperistalic strictureplasty (SSIS), which for the first time, offers a surgical option other than resection for patients with extensive Crohn's disease. SSIS is of vital importance to Crohn's patients since it is estimated that no more than half to two thirds of the bowel can be resected before absorption of nutrients is dramatically altered. Sign up to receive a brochure about surgical advances in the treatment of Crohn's disease.

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The recurrent nature of Crohn's makes the preservation of bowel a critical advantage to patients suffering from the disease. Stricturoplasty techniques, which alleviate obstructive symptoms without the need for intestinal resection, have been an important surgical innovation for treatment of Crohn's since they were first developed 25 years ago. But until Dr. Michelassi developed SSIS, strictureplasty was limited to small bowel strictures no longer than 15 cm, and of little help to the many Crohn's patients whose disease is more extensive. Unlike the initial stricturoplasty techniques, Dr. Michelassi's SSIS is well suited to lengthy strictures in the small bowel.

The procedure has quickly been adopted by surgeons at centers of excellence for the surgical treatment of Crohn's disease around the world. SSIS has proven highly effective in avoiding extensive small bowel resection for patients with disease of the jejunum and ileum, or with recurrent neoterminal ileitis.

A decade since its development, Dr. Michelassi published an international, multicenter prospective observational study of SSIS and its outcomes in the Journal of Colon and Rectal Surgery (see related link). The study involved 184 patients from six international centers in the US, Italy and Japan. The encouraging data shows that SSIS carries very low mortality and morbidity rates and acceptable recurrence rates. Worldwide experience at multiple centers demonstrates that SSIS is a safe and effective alternative to resection with concomitant benefit of preservation of significant bowel length.

SSIS has now been performed on more than 700 patients. In the course of examining patients five years post-surgery, Dr. Michelassi made a remarkable discovery. At the site of the repaired strictures, there was no trace of the Crohn's disease. He published a paper in The Annuals of Surgery in 2000 demonstrating histopathologic evidence that there is quiescence and regression of the disease following the surgery. Dr. Michelassi is currently conducting major funded research to determine if his new procedure also results in improved functionality of the bowel. If his research demonstrates that disease quiescence translates into resumption of function as he expects, side-to-side strictureplasty is poised to revolutionize the treatment of Crohn's disease.

One patient who recently underwent the new SSIS procedure with Dr. Michelassi is Kathy Munro, a wife and mother who was diagnosed with Crohn's disease in her early twenties. Over the next 2 decades, Kathy had undergone several surgeries to remove diseased bowel and was facing further surgery when she was referred to Dr. Michelassi by her gastroenterologist, who had heard Dr. Michelassi present his side-to-side strictureplasty at a medical conference. Kathy had lost a lot of weight and needed surgery that would preserve as much of her bowel as possiblewhich made her an ideal candidate for Dr. Michlelassis bowel-sparing procedure. Dr. Michelassis innovative Crohn's surgery involves dividing the diseased loop of bowel in half, moving one half over the other and joining the two half-loops together to create a larger passageway inside the bowel. And it was a complete success in Kathy Munros caseafter the surgery she was able happily to return to what she calls her normal life, returning to work and being able to enjoy her busy home life with her jazz musician husband and two teenage boys. Dr. Michelassi brought me back from the edge, she says, I am so grateful that I was able to benefit from his pioneering surgical technique for Crohn's disease.

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