P391 Side-to-side strictureplasty and its modification over the ileocecal valve for extensive Crohn’s ileitis: single-centre long-term outcome

Abstract Background Postoperative recurrence remains a challenging problem in patients with Crohn’s disease (CD). Ileal location and extensive disease are risks factor for surgical recurrence. To avoid short-bowel syndrome, strictureplasty techniques have been proposed. Over the years, the indication for strictureplasty has further expanded to long strictures. We evaluated the long-term effect of side-to-side isoperistaltic strictureplastie (SSIS) (according to the Michelassi technique or modification of this over the ileocecal valve (mSSIS)) and its effect on bowel preservation in CD patients with extensive bowel involvement. Methods Fifty-two CD patients with an affected ileal segment (≥ 20 cm) were included (Figure 1). Thirty-day postoperative morbidity was assessed using the comprehensive complication index (CCI). Patients were assessed clinically at 1 and 6 months postoperatively. An ileocolonoscopy and a magnetic resonance enterography were performed 6 months after surgery. Endoscopic disease activity was assessed according to the modified Rutgeerts score (MRS). Perioperative factors related to disease recurrence were evaluated. Clinical recurrence was defined as symptomatic endoscopically (MRS ≥ i2b) or radiologically confirmed stricture/inflammatory lesion requiring initiation/escalation of the medical treatment or surgery. Surgical recurrence was defined as the need for any surgical intervention within or away from the primary strictureplasty. Endoscopic remission was defined as MRS ≤ i1. Deep remission was defined as the combination of endoscopic remission and the absence of clinical symptoms. Results Mean CCI for SSIS was 1.9 (Figure 2). At a median follow-up of 70.8 months (range 9.6–118.8), 19 patients (47.5%) experienced clinical recurrence. Surgical recurrence occurred in seven patients (36.9%). Four patients needed resection of the SSIS. In two patients, a Heineke–Mikulicz strictureplasty was performed at the inlet of the SSIS. The median time to clinical recurrence was 29.3 months (11.4–62.8). The median time to surgical recurrence was 42.9 months (11.9–52.7) (Figure 3). None of the perioperative variables (gender, age at surgery, Montreal classification, smoking habits, former surgery, pre- and postoperative medical therapy, length of SSIS, associated surgery, postoperative complications) correlated with clinical recurrence. At the end of the follow-up, deep remission was reached in nine patients (22.5%). Conclusion SSIS is safe, effective and provides durable disease control in patients with extensive CD ileitis. The majority of patients (92.3%) maintain the original SSIS after a median follow-up of 70.8 months. Although not as frequent (15%), endoscopic remission has been observed when an mSSIS has been performed.

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