Le stricturoplastiche nel trattamento chirurgico della malattia di Crohn complicata

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G.M. SAMPIETRO, A. SARTANI, P. DANELLI, M. GHIZZONI, C. SPOSITO, G. MACONI, F. PARENTE, A.M. TASCHIERI

Ann. Ital. Chir., LXXIV, 6, 2003

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Introduction: Crohn’s disease is a panintestinal chronic
inflammatory condition. Its remitting-relapsing behaviour
may require in the single patient repeated surgeries, with
the aim of resolving the complications of the disease. The
awereness that surgery cannot resolve the disease has led, in
the last years, to the development of new “conservative surgical
techniques”, which preserve as much of the intestinal
tissue as possible. These techniques are minimal resection
and strictureplasty (SP). Aim of the study was to perform
a prospective analysis of the long-term outcome of SP in a
consecutive series of patients undergoing surgery for complicated
Crohn’s Disease at the Division of general surgery,
L. Sacco University Hospital, Milano, Italia.
Methods and Results: During the period of October 1992
to June 2002, 286 patients underwent surgical procedures
for jejunoileal Crohn’s disease. 116 of them underwent SP
resulting in a total of 217 procedures, of which: 111
Heineke-Mikulicz SP (51.2%), 36 ileoileal side-to-side SP
(16.6%), 40 ileoceacal SP (18.4%) and the remaining 30
ileocolic SP (13.8%), as previously described by A.M.
Taschieri. Fiftyone of the patients (23.5%) had concomitantly
a minimal bowel resection. Postoperative mortality
was nil, while in 3 cases (2.59%) repeated surgery was
necessary due to postsurgical complications. Time-to-event
estimates were performed using the Kaplan-Meier function.
Conclusions: mortality, morbidity, and long-term results in
this population of patients who underwent SP are encouraging
and in line with reports in the international literature.
It is suggested that SP, together with minimal bowel
resections, may be considered as first line surgical therapy
in patients with Crohn’s Disease.

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