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SHORT- AND LONG-TERM OUTCOMES FOLLOWING BIOLOGIC USE BEFORE NON-CONVENTIONAL STRICUREPLASTY FOR CROHN'S JEJUNOILEITIS
Mikhael Belkovsky
*, Lukas Schabl, Benjamin L. Cohen, Joshua Sommovilla, Tracy L. Hull, Stefan D. Holubar
Colorectal Surgery, Cleveland Clinic, Cleveland, OH
BackgroundNon-conventional strictureplasties, specifically the Finney and Michelassi techniques, are bowel-preserving surgeries for treating diffuse jejunoileal Crohn's Disease (CD). We investigated the use of biologics during non-conventional strictureplasty for Crohn's jejunoileitis and the association with short- and long-term outcomes.
MethodsWe conducted a retrospective review of all patients with CD who underwent non-conventional strictureplasty at our center, such as side-to-side antiperistaltic strictureplasty (SSAS) according to the Finney technique, and side-to-side isoperistaltic strictureplasty (SSIS) according to the Michelassi technique, from January 2000 to October 2022. Patients were categorized into BIO and NoBIO groups based on whether they were treated with biologics at the time of surgery or not. Our outcomes of interest were: (a) 30-day complications; (b) surgical recurrence. Statistical analysis was performed using R version 4.3.1.
ResultsA total of 71 patients underwent non-conventional strictureplasty: 80 SSAS and 14 SSIS. In the BIO group, 17 (24%) patients underwent surgery, with 15 receiving SSAS and 3 receiving SSIS Most patients (69%) also underwent a concurrent Heineke-Mikulicz strictureplasty or a concurrent small bowel resection (74.6%). The patients in the BIO and NoBIO groups had similar baseline characteristics (
Table 1). No difference was observed when comparing surgical recurrence rates (rate 52.9% vs. rate 48.1%, p=0.95), but a longer median time to recurrence was observed in the BIO group (4.7 vs. 4.4 years, p=0.004). (
Table 2).
ConclusionThe use of biologics at the time of non-conventional strictureplasty for diffuse jejunoileal Crohn's disease appears to be safe and is associated with a longer median time to recurrence.
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