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Return to Surgery for Crohn's Disease Spares Intestine Overview

More on Surgery for Crohn's Disease Spares Intestine

Surgery for Crohn's Disease Spares Intestine

New York (Jan 27, 2010)

Tray of surgical instruments

A surgery pioneered by Fabrizio Michelassi, MD, the Surgeon-in-Chief at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, offers a treatment for Crohn's disease that spares removing portions of a patient's intestines and reduces the risk that he or she will suffer from malnutrition. Research suggests that the procedure, known as the Michelassi strictureplasty, may be able to reverse Crohn's disease as well.

Crohn's disease inflames the lining of the intestines; scar tissue forms and narrows the intestine, making it difficult for food to pass and causing cramping. Surgeons can cut above and below the diseased area of the intestine and reconnect the two portions. However, the segment of intestine that is removed also contains areas of healthy, well functioning lining that can absorb nutrients. Therefore, strictureplasty is often a better choice.

Traditional Strictureplasty

The simplest strictureplasty involves opening the narrowing caused by a stricture and sewing up the incision crosswise in order to enlarge the width of the passageway. Thus, an incision is made lengthwise and the top and bottom edges of the incision are brought together and sewn together. This helps enlarge the width of the passageway, without removing any parts of the intestine. Sometimes, it is necessary to undergo multiple strictureplasties in a single operation if several areas of the small intestine are diseased.

Michelassi Strictureplasty

Dr. Fabrizio Michelassi
Dr. Fabrizio Michelassi

When repeated strictures involve a lengthy section of the intestine, the side-to-side isoperistaltic strictureplasty, also known as the "Michelassi strictureplasty" can be applied, Dr. Michelassi explained. "The difference between my procedure and traditional stricureplasty techniques is that my procedure lends itself to treatment of very advanced and very extensive Crohn's disease of the small bowel, while the other traditional strictureplasties do not."

Dr. Michelassi's procedure involves identifying the diseased loop of the small intestine and cutting the loop at its midpoint. The two half loops are stacked on top of one another in a way that the narrowed areas of one loop are placed over the dilated areas of the other loop. Dr. Michelassi describes the two loops as looking like the way your forearms would look if you were giving someone a big hug. The intestinal loops are then cut lengthwise and their edges are sewn together to form one large loop with a bigger diameter. Dr. Michelassi describes the procedure as "creating one good bowel out of two diseased bowels."

Research suggests that the chance for disease recurrence is less with strictureplasties than with resections. In addition, strictureplasties, including the Michelassi strictureplasty, cause a reversal of Crohn's disease in the areas of treatment. It is not clear why this happens as no part of the intestine is removed, Dr. Michelassi explained. "The procedure is an incredible improvement and extension of the concept of saving the bowel rather than resecting the bowel," said Dr. Michelassi.

Currently, Dr. Michelassi and colleagues are performing research to confirm that Michelassi strictureplasty causes disease regression and also are studying whether the function of the affected bowel is ameliorated following surgery. This research also may open a window on why the disease regresses in terms of what genes are activated by strictureplasty. "Maybe the same genes that are turned on by strictureplasty and help the mucosa to return back to normal are the same genes that for some reason are turned off at the beginning of the disease," Dr. Michelassi hypothesized. This could lead to discovery of medications that can be used to activate these genes in patients with Crohn's disease. "This is a very preliminary, but exciting avenue of research," he said.

Faculty Contributing to this Article:

Fabrizio Michelassi, MD, FACS, is the Surgeon-in-Chief at NewYork-Presbyterian Hospital, and the Chairman of Surgery at Weill Cornell Medical College.

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