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Victor W. Fazio - One of the best experts on this subject based on the ideXlab platform.
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an international multicenter prospective observational study of the side to side isoperistaltic Strictureplasty in crohn s disease
Diseases of The Colon & Rectum, 2007Co-Authors: Fabrizio Michelassi, Victor W. Fazio, Roger D. Hurst, Gilberto Poggioli, Francesco Tonelli, Iwao Sasaki, Gianluca M. Sampietro, Gaurav A. Upadhyay, A M Taschieri, Marilena FaziAbstract:Purpose:The side-to-side Strictureplasty is a bowel-sparing alternative to resection in the treatment of stricturing Crohn's disease. This study was initiated to review the adoption of the side-to-side Strictureplasty as a new surgical technique and the relative outcomes a decade after its descripti
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Safety and efficacy of Strictureplasty for Crohn's disease: a systematic review and meta-analysis.
Diseases of the colon and rectum, 2007Co-Authors: Takayuki Yamamoto, Victor W. Fazio, Paris P. TekkisAbstract:This study was designed to review safety and efficacy of Strictureplasty for Crohn’s disease. A literature search was performed to identify studies published between 1975 and 2005 that reported the outcome of Strictureplasty. Systematic review was performed on the following subjects separately: 1) overall experience of Strictureplasty; 2) postoperative complications; 3) postoperative recurrence and site of recurrence; 4) factors affecting postoperative complications and recurrence; 5) short-bowel syndrome; and 6) cancer risk. Meta-analysis of recurrence rate after Strictureplasty was performed by using random-effect model and meta-regressive techniques. A total of 1,112 patients who underwent 3,259 strictureplasties (Heineke-Mikulicz, 81 percent; Finney, 10 percent; side-to-side isoperistaltic, 5 percent) were identified. The sites of Strictureplasty were jejunum and/or ileum (94 percent), previous anastomosis (4 percent), duodenum (1 percent), and colon (1 percent). After jejunoileal Strictureplasty, including ileocolonic Strictureplasty, septic complications (leak/fistula/abscess) occurred in 4 percent of patients. Overall surgical recurrence was 23 percent (95 percent confidence interval, 17-0 percent). Using meta-regressive analysis, the five-year recurrence rate after Strictureplasty was 28 percent. In 90 percent of patients, recurrence occurred at nonStrictureplasty sites, and the site-specific recurrence rate was 3 percent. Two patients developed adenocarcinoma at the site of previous jejunoileal Strictureplasty. The experience of duodenal or colonic Strictureplasty was limited. Strictureplasty is a safe and effective procedure for jejunoileal Crohn’s disease, including ileocolonic recurrence, and it has the advantage of protecting against further small bowel loss. However, the place for Strictureplasty is less well defined in duodenal and colonic diseases.
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An International, Multicenter, Prospective, Observational Study of the Side-to-Side Isoperistaltic Strictureplasty in Crohn’s Disease
Diseases of the colon and rectum, 2007Co-Authors: Fabrizio Michelassi, Victor W. Fazio, Roger D. Hurst, Gilberto Poggioli, Francesco Tonelli, Angelo Taschieri, Iwao Sasaki, Gianluca M. Sampietro, Gaurav A. Upadhyay, Marilena FaziAbstract:Purpose:The side-to-side Strictureplasty is a bowel-sparing alternative to resection in the treatment of stricturing Crohn's disease. This study was initiated to review the adoption of the side-to-side Strictureplasty as a new surgical technique and the relative outcomes a decade after its descripti
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Strictureplasty in diffuse Crohn's jejunoileitis: safe and durable.
Diseases of the colon and rectum, 2002Co-Authors: David W. Dietz, Victor W. Fazio, Ian C. Lavery, Scott A. Strong, James M. Church, Tracy L. Hull, Sylvio Laureti, Feza H. Remzi, Anthony J. SenagoreAbstract:PURPOSE: As an alternative to resection, Strictureplasty may allow for preservation of intestinal length and avoidance of short-bowel syndrome in patients with diffuse Crohn's jejunoileitis. However, the long-term durability of the procedure and its safety have not been confirmed. The purpose of this study was to report our experience with Strictureplasty for diffuse Crohn's jejunoileitis. METHODS: Between 1984 and 1999, 123 patients underwent a laparotomy that included an index Strictureplasty for diffuse jejunoileitis. Patient history, operative details, and postoperative morbidities were obtained by chart review. Nineteen patients (15 percent) were receiving total parenteral nutrition for short-bowel syndrome, and 81 (66 percent) were taking chronic steroids. Total number of strictureplasties performed was 701 (median, 5/patient). Seventy percent of patients underwent a synchronous bowel resection. Follow-up information was determined by personal or phone interviews. Recurrence was defined as the need for reoperation, and risk was calculated by the Kaplan-Meier method. Patients with diffuse jejunoileitis were also compared with 219 patients with limited small-bowel Crohn's disease undergoing Strictureplasty. RESULTS: The overall morbidity rate was 20 percent, with septic complications occurring in 6 percent. The surgical recurrence rate was 29 percent with a median follow-up period of 6.7 (range, 1-16) years. The recurrence rate in diffuse jejunoileitis patients did not differ from that seen in patients with limited small-bowel Crohn's disease (P= 0.38). Short duration of disease and short interval since last surgery were significant predictors of accelerated recurrence (P= 0.008 and 0.04, respectively). CONCLUSIONS: Strictureplasty is a safe and durable alternative to resection in diffuse Crohn's jejunoileitis. Patients with a short duration of disease and short interval since last surgery are at higher risk for accelerated recurrence. Patients with diffuse jejunoileitis do not appear to be at higher risk for recurrence than patients with more limited Crohn's disease.
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Obstruction in Crohn's Disease: Strictureplasty Versus Resection.
Current treatment options in gastroenterology, 2000Co-Authors: Silvio Laureti, Victor W. FazioAbstract:Although the long-term outcome of patients undergoing Strictureplasty is still to be determined, safety and effectiveness of this technique have been widely demonstrated in several reports during the past decade, with follow-up up to 10 years. However, since contraindications exist, careful selection of patients is needed. Thus, Strictureplasty does not replace resection, but must be considered as a valid adjunct to conventional excisions surgery for obstructive small bowel Crohn’s disease, expecially when the patient is vulnerable to short bowel syndrome.
Fabrizio Michelassi - One of the best experts on this subject based on the ideXlab platform.
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Michelassi II Strictureplasty for Crohn's Disease: A New Side-to-Side Isoperistaltic Strictureplasty With Discontinuous Bowel Loops.
Annals of surgery, 2020Co-Authors: Diane Mege, Fabrizio MichelassiAbstract:Objective We report on a new side-to-side isoperistaltic Strictureplasty (SSIS), the Michelassi II or end-to-side-to-side-to-end Strictureplasty, performed with discontinuous bowel loops. Summary background data The SSIS Michelassi Strictureplasty was described a quarter of a century ago to avoid massive bowel resections in patients with extensive fibrostenosing Crohn's jejuno-ileitis. Methods The end-to-side-to-side-to-end Strictureplasty is performed in patients presenting with 3 severely fibrotic and deformed bowel loops separated by 2 diseased segments with sequential strictures. After the resection of the 3 severely diseased segments, the remaining 2 discontinuous segments are used to perform a SSIS, according to the original description. The 2 ends of the SSIS are then anastomosed with the proximal and the distal bowel, respectively. In the presence of discrepancy in length between the 2 discontinuous segments, the proximal small bowel is recruited to equalize the length and aid in the performance of the SSIS. Conclusions The Michelassi II, or the end-to-side-to-side-to-end Strictureplasty, is a variant of the original SSIS technique to address severe and extensive small bowel Crohn's disease presenting with 3 severely fibrotic and deformed bowel loops separated by 2 diseased segments with sequential strictures.
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Long-term Results of the Side-to-side Isoperistaltic Strictureplasty in Crohn Disease: 25-year Follow-up and Outcomes.
Annals of surgery, 2019Co-Authors: Fabrizio Michelassi, Diane Mege, Michele Rubin, Roger D. HurstAbstract:OBJECTIVE Review the long-term outcomes of the side-to-side isoperistaltic Strictureplasty (SSIS) and its effects on bowel preservation in Crohn disease (CD). SUMMARY BACKGROUND DATA The first SSIS was performed 25 years ago as an alternative to resection in the treatment of extensive fibrostenosing jejuno-ileal CD. METHODS Prospective study (January 1992-December 2016) of all patients with a SSIS performed by the authors. Long-term outcomes were evaluated radiographically, endoscopically, and histopathologically. RESULTS Sixty patients [14.4% of patients with jejuno-ileal bowel CD; 31 females; median age 36 (12-69) years] underwent 61 SSIS's for partial intestinal obstruction. Median length of preserved small bowel was 50 (20-148) cm. Associated strictureplasties and bowel resection were performed in 44% and 80%, respectively. Postoperative mortality occurred in 1 (PE on POD#8) and postoperative morbidity in 7 (12%). There were no sutureline dehiscences. SSIS resulted in resolution of preoperative symptoms in all. After a median follow-up of 11 years (range 1 mo-25 yrs), symptomatic recurrence was observed in 61%: 15 patients at the SSIS and 19 away from it (2 cases unclear location; 7 patients with >1 recurrence). Of 15 recurrences at SSIS's, 11 required surgical treatment (revision or Strictureplasty in 6, SSIS removal in 5). Fifty-one patients (86%) maintain the original SSIS to date. CONCLUSIONS SSIS is a safe, effective, and durable Strictureplasty in patients with extensive fibrostenosing CD of the small bowel. Half the surgical recurrences on SSIS can be managed by subsequent revision or Strictureplasty. The majority of patients maintain the original SSIS after a median follow-up of 11 years.
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How I do it: Side-to-side isoperistaltic Strictureplasty for extensive Crohn's disease.
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2012Co-Authors: Léon Maggiori, Fabrizio MichelassiAbstract:Introduction Bowel-sparing surgical techniques, such as the Heineke–Mikulicz and the Finney Strictureplasty, have been proposed as an alternative to lengthy intestinal resection in the treatment of small bowel strictures in Crohn’s disease. However, these conventional Strictureplasty techniques lend themselves poorly to cases of multiple short strictures closely clustered over a lengthy small bowel segment.
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An International, Multicenter, Prospective, Observational Study of the Side-to-Side Isoperistaltic Strictureplasty in Crohn’s Disease
Diseases of the Colon & Rectum, 2007Co-Authors: Fabrizio Michelassi, Gilberto Poggioli, Francesco Tonelli, Angelo Taschieri, Iwao Sasaki, Victor Fazio, Gaurav Upadhyay, Roger Hurst, Gianluca M. Sampietro, Marilena FaziAbstract:Purpose The side-to-side Strictureplasty is a bowel-sparing alternative to resection in the treatment of stricturing Crohn’s disease. This study was initiated to review the adoption of the side-to-side Strictureplasty as a new surgical technique and the relative outcomes a decade after its description. Methods A total of 184 unique patients from six centers in the United States, Italy, and Japan served as the basis for this study. A questionnaire instrument was used to assemble prospectively acquired preoperative, intraoperative, perioperative, and postoperative data from each center into a computer-generated database. Results Average age at surgery for patients selected for a side-to-side Strictureplasty varied significantly between centers (minimum, 31.0 years; maximum, 39.5 years, P < 0.006). Use of the side-to-side Strictureplasty technique for primary Crohn’s disease vs . surgically recurrent disease also varied significantly by center (primary minimum, 16.7 percent; maximum, 68.6 percent, P < 0.03). Furthermore, length of diseased bowel selected for construction of a side-to-side Strictureplasty was significantly different among centers (minimum, 20.8 ± 9.9 cm; maximum, 64.3 ± 29.3 cm, P < 0.001). Use of synchronous bowel resection away from the site of the side-to-side Strictureplasty was relatively common (minimum, 21.1 percent; maximum, 66.7 percent) as it was with the use of additional synchronous strictureplasties (minimum, 41.9 percent; maximum, 83.3 percent). The six centers experienced a low number of complications (minimum, 5.7 percent; maximum, 20.8 percent). Forty-one of 184 total patients required surgery for recurrent disease, with an average time to recurrence of 35 months. The difference of reoperation-free five-year survival experienced by the patients in the six centers was not statistically significant, with a cumulative reoperation-free five-year survival of 77 percent across all centers. Conclusions Worldwide implementation of the side-to-side Strictureplasty technique and its variations has occurred. This procedure carries a very low mortality and morbidity rate, with acceptable recurrence rates.
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an international multicenter prospective observational study of the side to side isoperistaltic Strictureplasty in crohn s disease
Diseases of The Colon & Rectum, 2007Co-Authors: Fabrizio Michelassi, Victor W. Fazio, Roger D. Hurst, Gilberto Poggioli, Francesco Tonelli, Iwao Sasaki, Gianluca M. Sampietro, Gaurav A. Upadhyay, A M Taschieri, Marilena FaziAbstract:Purpose:The side-to-side Strictureplasty is a bowel-sparing alternative to resection in the treatment of stricturing Crohn's disease. This study was initiated to review the adoption of the side-to-side Strictureplasty as a new surgical technique and the relative outcomes a decade after its descripti
Takayuki Yamamoto - One of the best experts on this subject based on the ideXlab platform.
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Strictureplasty vs resection in small bowel crohn s disease an evaluation of short term outcomes and recurrence
Colorectal Disease, 2007Co-Authors: George E. Reese, Takayuki Yamamoto, Sanjay Purkayastha, Henry S. Tilney, A. C. Von Roon, Paris TekkisAbstract:Aim To compare postoperative adverse events and recurrence following Strictureplasty or bowel resection in patients with small bowel Crohn's disease (CD). Method A literature search was performed to identify studies published between 1980 and 2006 comparing outcomes of CD patients undergoing either Strictureplasty or bowel resection. Hazard ratios were calculated from Kaplan–Meier plots of cumulative recurrence data. Quality assessment of the included studies was performed. Random-effect meta-analytical techniques were employed. Sensitivity analysis and assessment of heterogeneity were performed. Results Seven studies comprising 688 CD patients (Strictureplasty n = 311, 45%; resection with or without Strictureplasty n = 377, 55%) were included. Patients undergoing Strictureplasty alone had a lower risk of developing postoperative complications than those who underwent resection (OR = 0.60, 95% CI: 0.31–1.16) although this was not statistically significant (P = 0.13). Surgical recurrence after Strictureplasty was more likely than after resection (OR = 1.36, 95% CI: 0.96–1.93, P = 0.09). Patients who had a resection had a significantly longer recurrence-free survival than those undergoing Strictureplasty alone (HR = 1.08, 95% CI: 1.02–1.15, P = 0.01). Conclusion Patients with small bowel CD undergoing Strictureplasty alone may have fewer postoperative complications than those undergoing a concomitant bowel resection. However, surgical recurrence maybe higher following Strictureplasty alone than with a concomitant small bowel resection. Patients may require appropriate preoperative counselling regarding the pros and cons of each operative technique.
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Safety and efficacy of Strictureplasty for Crohn's disease: a systematic review and meta-analysis.
Diseases of the colon and rectum, 2007Co-Authors: Takayuki Yamamoto, Victor W. Fazio, Paris P. TekkisAbstract:This study was designed to review safety and efficacy of Strictureplasty for Crohn’s disease. A literature search was performed to identify studies published between 1975 and 2005 that reported the outcome of Strictureplasty. Systematic review was performed on the following subjects separately: 1) overall experience of Strictureplasty; 2) postoperative complications; 3) postoperative recurrence and site of recurrence; 4) factors affecting postoperative complications and recurrence; 5) short-bowel syndrome; and 6) cancer risk. Meta-analysis of recurrence rate after Strictureplasty was performed by using random-effect model and meta-regressive techniques. A total of 1,112 patients who underwent 3,259 strictureplasties (Heineke-Mikulicz, 81 percent; Finney, 10 percent; side-to-side isoperistaltic, 5 percent) were identified. The sites of Strictureplasty were jejunum and/or ileum (94 percent), previous anastomosis (4 percent), duodenum (1 percent), and colon (1 percent). After jejunoileal Strictureplasty, including ileocolonic Strictureplasty, septic complications (leak/fistula/abscess) occurred in 4 percent of patients. Overall surgical recurrence was 23 percent (95 percent confidence interval, 17-0 percent). Using meta-regressive analysis, the five-year recurrence rate after Strictureplasty was 28 percent. In 90 percent of patients, recurrence occurred at nonStrictureplasty sites, and the site-specific recurrence rate was 3 percent. Two patients developed adenocarcinoma at the site of previous jejunoileal Strictureplasty. The experience of duodenal or colonic Strictureplasty was limited. Strictureplasty is a safe and effective procedure for jejunoileal Crohn’s disease, including ileocolonic recurrence, and it has the advantage of protecting against further small bowel loss. However, the place for Strictureplasty is less well defined in duodenal and colonic diseases.
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Strictureplasty vs resection in small bowel Crohn's disease: an evaluation of short‐term outcomes and recurrence
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2007Co-Authors: George E. Reese, Takayuki Yamamoto, Sanjay Purkayastha, Henry S. Tilney, A. C. Von Roon, Paris TekkisAbstract:Aim To compare postoperative adverse events and recurrence following Strictureplasty or bowel resection in patients with small bowel Crohn's disease (CD). Method A literature search was performed to identify studies published between 1980 and 2006 comparing outcomes of CD patients undergoing either Strictureplasty or bowel resection. Hazard ratios were calculated from Kaplan–Meier plots of cumulative recurrence data. Quality assessment of the included studies was performed. Random-effect meta-analytical techniques were employed. Sensitivity analysis and assessment of heterogeneity were performed. Results Seven studies comprising 688 CD patients (Strictureplasty n = 311, 45%; resection with or without Strictureplasty n = 377, 55%) were included. Patients undergoing Strictureplasty alone had a lower risk of developing postoperative complications than those who underwent resection (OR = 0.60, 95% CI: 0.31–1.16) although this was not statistically significant (P = 0.13). Surgical recurrence after Strictureplasty was more likely than after resection (OR = 1.36, 95% CI: 0.96–1.93, P = 0.09). Patients who had a resection had a significantly longer recurrence-free survival than those undergoing Strictureplasty alone (HR = 1.08, 95% CI: 1.02–1.15, P = 0.01). Conclusion Patients with small bowel CD undergoing Strictureplasty alone may have fewer postoperative complications than those undergoing a concomitant bowel resection. However, surgical recurrence maybe higher following Strictureplasty alone than with a concomitant small bowel resection. Patients may require appropriate preoperative counselling regarding the pros and cons of each operative technique.
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Postoperative change of mucosal inflammation at Strictureplasty segment in Crohn's disease: cytokine production and endoscopic and histologic findings.
Diseases of the colon and rectum, 2005Co-Authors: Takayuki Yamamoto, Satoru Umegae, Tatsushi Kitagawa, Koichi MatsumotoAbstract:PURPOSE This study was designed to examine postoperative change of mucosal inflammation at Strictureplasty segment in Crohn's disease mainly by cytokine measurements. METHODS Patients who underwent Strictureplasty for Crohn's disease in the terminal ileum were investigated. Mucosal samples at the Strictureplasty site were obtained during operation. At 3, 6, and 12 months after operation, biopsy specimens were taken from the Strictureplasty site and macroscopically normal ileum at endoscopy. Mucosal cytokine concentrations were measured by enzyme-linked immunosorbent assay. RESULTS The mucosal concentrations of proinflammatory cytokines (interleukin-1beta, interleukin-6, interleukin-8, and tumor necrosis factor-alpha) and anti-inflammatory mediator (interleukin-1 receptor antagonist) at the Strictureplasty segment greatly increased at the time of operation. Interleukin-1beta, interleukin-1 receptor antagonist, interleukin-6, interleukin-8, and tumor necrosis factor-alpha concentrations at the Strictureplasty segment decreased during a 12-month period after operation. Twelve months after operation there was no significant difference in each cytokine concentration between the Strictureplasty and macroscopically normal segments. The mucosal interleukin-1 receptor antagonist/interleukin-1beta ratio at the Strictureplasty segment increased during a 12-month period after operation. Twelve months after operation there was no significant difference in the ratio between the Strictureplasty and macroscopically normal segments. The endoscopic and histologic severities of mucosal inflammation at the Strictureplasty site also decreased; however, their findings were not normalized during the study. CONCLUSIONS During one year after Strictureplasty for Crohn's disease, cytokine production at the Strictureplasty segment was decreased to the level of the macroscopically normal ileum and an imbalance between proinflammatory and antiinflammatory cytokines was corrected.
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Long Strictureplasty is as safe and effective as short Strictureplasty in small-bowel Crohn's disease.
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2004Co-Authors: T. Shatari, M. A. Clark, Takayuki Yamamoto, A. Menon, C. Keh, J. Alexander‐williams, M. R. B. KeighleyAbstract:Background For the past 20 years it has been shown that intestinal Strictureplasty is safe and effective in the management of short Strictureplasty. Long Strictureplasty (> 20 cm) may be an alternative to resection in some patients, especially in diffuse disease or after previous extensive resections. We reviewed the outcome of long Strictureplasty for Crohn's Disease, to examine safety and recurrence rates, compared with conventional short Strictureplasty. Methods Sixty-two patients have undergone single Strictureplasty for jejunoileal Crohn's disease since 1974. Median follow-up was 121 (range 7–253) months. Twenty-one operations involved a single long Strictureplasty, and 41 operations had a single short Strictureplasty. Results No significant differences were identified between the groups. The postoperative complications in long Strictureplasty included 2 abscesses only and after short Strictureplasty there was one anastomotic leak and one postoperative abscess. The median hospital stay was 10 days after long Strictureplasty and 9 days after short Strictureplasty. Three-, 5- and 10-year disease-free rates for long and short Strictureplasty, respectively, were 3-year 80.4% and 62.1%; 5-year 55.2% and 49.8% and 10-year 49.1% and 33.5% (NS). Conclusions These data indicate that long Strictureplasty is safe and produces equivalent results to conventional (short) Strictureplasty.
Francesco Tonelli - One of the best experts on this subject based on the ideXlab platform.
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Symptomatic duodenal Crohn's disease: is Strictureplasty the right choice?
Journal of Crohn's & colitis, 2012Co-Authors: Francesco Tonelli, Giovanni Alemanno, Francesco Bellucci, Adriana Focardi, Alessandro Sturiale, Francesco GiudiciAbstract:Primary duodenal localization of Crohn's disease (CD) is rare. Medical therapy can control symptoms, but surgery is required when progressive obstructive symptoms occur. Surgical options include bypass, resection, or Strictureplasty, but it is still not clear which should be the treatment of choice. Reviewing the medical records of 1253 patients undergoing surgery for CD between January 1986 and December 2011 at the Digestive Surgery Unit of the Department of Clinical Physiopathology of the University of Florence, 10 patients (6 males and 4 females) underwent operations for duodenal CD. Four patients had only a duodenal localization, 6 patients had synchronous involvement of other intestinal tracts. Strictures were distributed in all the duodenal portions: in 7 patients there were single lesions, in 3 patients there were multiple lesions. Eight patients were treated with Strictureplasty: 5 with the Heineke-Mikulicz technique, 2 with Jaboulay, and 1 with a pedunculated jejunal patch. Two patients were treated with resection: one with a B2 gastro-duodenal resection, and 1 with a duodenal-jejunal resection and an end to side duodeno-jejunal anastomosis. Follow up of the patients was from 2 to 18 years. No recurrence of duodenal CD was observed in the 2 patients treated with resection, while 2 of the 8 patients treated with Strictureplasty had a recurrence. In our experience, Strictureplasty is indicated when less than 2 strictures are present in the 2nd or 3rd duodenal portion. In cases with multiple strictures localized in the 1st or the distal duodenal portion, resection is preferable.
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Ileocecal Strictureplasty for Crohn's disease: long-term results and comparison with ileocecal resection.
World journal of surgery, 2010Co-Authors: Francesco Tonelli, Marilena Fazi, Carmela Di MartinoAbstract:Background The aim of the present study was to evaluate Strictureplasty as the first choice for surgical treatment for Crohn’s terminal ileitis.
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An International, Multicenter, Prospective, Observational Study of the Side-to-Side Isoperistaltic Strictureplasty in Crohn’s Disease
Diseases of the Colon & Rectum, 2007Co-Authors: Fabrizio Michelassi, Gilberto Poggioli, Francesco Tonelli, Angelo Taschieri, Iwao Sasaki, Victor Fazio, Gaurav Upadhyay, Roger Hurst, Gianluca M. Sampietro, Marilena FaziAbstract:Purpose The side-to-side Strictureplasty is a bowel-sparing alternative to resection in the treatment of stricturing Crohn’s disease. This study was initiated to review the adoption of the side-to-side Strictureplasty as a new surgical technique and the relative outcomes a decade after its description. Methods A total of 184 unique patients from six centers in the United States, Italy, and Japan served as the basis for this study. A questionnaire instrument was used to assemble prospectively acquired preoperative, intraoperative, perioperative, and postoperative data from each center into a computer-generated database. Results Average age at surgery for patients selected for a side-to-side Strictureplasty varied significantly between centers (minimum, 31.0 years; maximum, 39.5 years, P < 0.006). Use of the side-to-side Strictureplasty technique for primary Crohn’s disease vs . surgically recurrent disease also varied significantly by center (primary minimum, 16.7 percent; maximum, 68.6 percent, P < 0.03). Furthermore, length of diseased bowel selected for construction of a side-to-side Strictureplasty was significantly different among centers (minimum, 20.8 ± 9.9 cm; maximum, 64.3 ± 29.3 cm, P < 0.001). Use of synchronous bowel resection away from the site of the side-to-side Strictureplasty was relatively common (minimum, 21.1 percent; maximum, 66.7 percent) as it was with the use of additional synchronous strictureplasties (minimum, 41.9 percent; maximum, 83.3 percent). The six centers experienced a low number of complications (minimum, 5.7 percent; maximum, 20.8 percent). Forty-one of 184 total patients required surgery for recurrent disease, with an average time to recurrence of 35 months. The difference of reoperation-free five-year survival experienced by the patients in the six centers was not statistically significant, with a cumulative reoperation-free five-year survival of 77 percent across all centers. Conclusions Worldwide implementation of the side-to-side Strictureplasty technique and its variations has occurred. This procedure carries a very low mortality and morbidity rate, with acceptable recurrence rates.
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an international multicenter prospective observational study of the side to side isoperistaltic Strictureplasty in crohn s disease
Diseases of The Colon & Rectum, 2007Co-Authors: Fabrizio Michelassi, Victor W. Fazio, Roger D. Hurst, Gilberto Poggioli, Francesco Tonelli, Iwao Sasaki, Gianluca M. Sampietro, Gaurav A. Upadhyay, A M Taschieri, Marilena FaziAbstract:Purpose:The side-to-side Strictureplasty is a bowel-sparing alternative to resection in the treatment of stricturing Crohn's disease. This study was initiated to review the adoption of the side-to-side Strictureplasty as a new surgical technique and the relative outcomes a decade after its descripti
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An International, Multicenter, Prospective, Observational Study of the Side-to-Side Isoperistaltic Strictureplasty in Crohn’s Disease
Diseases of the colon and rectum, 2007Co-Authors: Fabrizio Michelassi, Victor W. Fazio, Roger D. Hurst, Gilberto Poggioli, Francesco Tonelli, Angelo Taschieri, Iwao Sasaki, Gianluca M. Sampietro, Gaurav A. Upadhyay, Marilena FaziAbstract:Purpose:The side-to-side Strictureplasty is a bowel-sparing alternative to resection in the treatment of stricturing Crohn's disease. This study was initiated to review the adoption of the side-to-side Strictureplasty as a new surgical technique and the relative outcomes a decade after its descripti
Marilena Fazi - One of the best experts on this subject based on the ideXlab platform.
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Ileocecal Strictureplasty for Crohn's disease: long-term results and comparison with ileocecal resection.
World journal of surgery, 2010Co-Authors: Francesco Tonelli, Marilena Fazi, Carmela Di MartinoAbstract:Background The aim of the present study was to evaluate Strictureplasty as the first choice for surgical treatment for Crohn’s terminal ileitis.
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An International, Multicenter, Prospective, Observational Study of the Side-to-Side Isoperistaltic Strictureplasty in Crohn’s Disease
Diseases of the Colon & Rectum, 2007Co-Authors: Fabrizio Michelassi, Gilberto Poggioli, Francesco Tonelli, Angelo Taschieri, Iwao Sasaki, Victor Fazio, Gaurav Upadhyay, Roger Hurst, Gianluca M. Sampietro, Marilena FaziAbstract:Purpose The side-to-side Strictureplasty is a bowel-sparing alternative to resection in the treatment of stricturing Crohn’s disease. This study was initiated to review the adoption of the side-to-side Strictureplasty as a new surgical technique and the relative outcomes a decade after its description. Methods A total of 184 unique patients from six centers in the United States, Italy, and Japan served as the basis for this study. A questionnaire instrument was used to assemble prospectively acquired preoperative, intraoperative, perioperative, and postoperative data from each center into a computer-generated database. Results Average age at surgery for patients selected for a side-to-side Strictureplasty varied significantly between centers (minimum, 31.0 years; maximum, 39.5 years, P < 0.006). Use of the side-to-side Strictureplasty technique for primary Crohn’s disease vs . surgically recurrent disease also varied significantly by center (primary minimum, 16.7 percent; maximum, 68.6 percent, P < 0.03). Furthermore, length of diseased bowel selected for construction of a side-to-side Strictureplasty was significantly different among centers (minimum, 20.8 ± 9.9 cm; maximum, 64.3 ± 29.3 cm, P < 0.001). Use of synchronous bowel resection away from the site of the side-to-side Strictureplasty was relatively common (minimum, 21.1 percent; maximum, 66.7 percent) as it was with the use of additional synchronous strictureplasties (minimum, 41.9 percent; maximum, 83.3 percent). The six centers experienced a low number of complications (minimum, 5.7 percent; maximum, 20.8 percent). Forty-one of 184 total patients required surgery for recurrent disease, with an average time to recurrence of 35 months. The difference of reoperation-free five-year survival experienced by the patients in the six centers was not statistically significant, with a cumulative reoperation-free five-year survival of 77 percent across all centers. Conclusions Worldwide implementation of the side-to-side Strictureplasty technique and its variations has occurred. This procedure carries a very low mortality and morbidity rate, with acceptable recurrence rates.
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an international multicenter prospective observational study of the side to side isoperistaltic Strictureplasty in crohn s disease
Diseases of The Colon & Rectum, 2007Co-Authors: Fabrizio Michelassi, Victor W. Fazio, Roger D. Hurst, Gilberto Poggioli, Francesco Tonelli, Iwao Sasaki, Gianluca M. Sampietro, Gaurav A. Upadhyay, A M Taschieri, Marilena FaziAbstract:Purpose:The side-to-side Strictureplasty is a bowel-sparing alternative to resection in the treatment of stricturing Crohn's disease. This study was initiated to review the adoption of the side-to-side Strictureplasty as a new surgical technique and the relative outcomes a decade after its descripti
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An International, Multicenter, Prospective, Observational Study of the Side-to-Side Isoperistaltic Strictureplasty in Crohn’s Disease
Diseases of the colon and rectum, 2007Co-Authors: Fabrizio Michelassi, Victor W. Fazio, Roger D. Hurst, Gilberto Poggioli, Francesco Tonelli, Angelo Taschieri, Iwao Sasaki, Gianluca M. Sampietro, Gaurav A. Upadhyay, Marilena FaziAbstract:Purpose:The side-to-side Strictureplasty is a bowel-sparing alternative to resection in the treatment of stricturing Crohn's disease. This study was initiated to review the adoption of the side-to-side Strictureplasty as a new surgical technique and the relative outcomes a decade after its descripti
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Indications and Results of Side-to-Side Isoperistaltic Strictureplasty in Crohn's Disease
Diseases of the colon and rectum, 2004Co-Authors: Francesco Tonelli, Massimo Fedi, G. Matteo Paroli, Marilena FaziAbstract:Purpose: Strictureplasty has commonly been used for short stenotic tracts, but it has rarely been applied to stenoses longer than 10 cm. Michelassi proposed a side-to-side isoperistaltic Strictureplasty for single or multiple strictures that affected long bowel tracts. The experience and results obtained to date with this type of Strictureplasty are limited. We therefore decided to review the cases in which we performed this procedure. Methods: Thirty-one patients, aged 21 to 66 years, underwent this operation between August 1996 and October 2002. Indications for surgery included subocclusion in 22 patients, malnutrition in 9 patients, and fistula or abscess in 6 patients. Two side-to-side isoperistaltic strictureplasties have been performed in jejunum, 6 in jejunum-ileum, 16 in the proximal ileum, 1 in terminal ileum, and 6 in the ileo-cecal tract. Results: The average length ofside-to-side isoperistaltic Strictureplasty as 32. 1 cm (range, 10–54 cm). Sixteen patients also underwent concomitant bowel resection and 17 patients have received additional Strictureplasty. There was no perioperative mortality, nor were there any postoperative complications requiring reoperation. In all patients intestinal occlusion and malnutrition were resolved. Decrease of activity indices was observed in 62. 3 percent of patients within 6 months after surgery. At an average follow-up of 26. 4 months, six patients required reoperation, but in only one of them did the recurrence involve a previous Strictureplasty site. In that case the side-to-side isoperistaltic Strictureplasty was soft and was without signs of inflammation or stenosis. Conclusions: Side-to-side isoperistaltic Strictureplasty seems to provide a technical solution leading to improvement when long intestinal inflamed tract are treated. Longer follow-up and larger experience is needed to validate this observation.