Strictureplasty (and other) video

[Sparkle2012]

I found this video on youtube which describes this surgery (and others). Am I correct in assuming that the cut is lengthwise across the stricture -- the lips of that cut are then pulled open and around the opposite side to the back where the seams are met and sewn, leaving the inside lining of that area now on the outside and the stricture is now seen on the exterior? If that is correct, doesn't that create pockets or tunnels that might trap and hold food? I don't quite understand the surgery, but it's great there is no loss of bowel length. if anyone understands this, can you confirm back? I'm a person that has to wrap my head around things thoroughly so I can move on. Bless you all in this forum. You add such comfort to the newly diagnosed. Doctors just don't give enough info.

video on YouTube:

http://www.youtube.com/watch?v=eW3hQE8JP7s&feature=youtube_gdata_player

 

[Kelly2]

They cut a lengthwise slit in the scarred obstructed area. Then they sew or staple the lips of the slit together vertically instead of lengthwise. This makes a widened area where the obstruction was so things can flow thru easily. Take a look at this link - it has a diagram which shows how its done. My child had a strictureplasty for a stricture that would not go away, despite multiple dilations. The recovery time was incredibly brief, and resolved the issue, it never came back again.

http://emedicine.medscape.com/article/1893397-overview

Does that make sense now? Let me know if you have any questions.

 

[Sparkle2012]

oh my gosh --- that was the simplest explanation yet. Yes, I totally get it now. Thank you so much for clarifying this for me. I was cutting slits in tubes last night trying to figure it out...ha (I'm a bit driven when I want to understand something)

 

[Sparkle2012]

Can they do this surgery laproscopically do you know?

 

[Jennifer]

http://www.crohnsforum.com/wiki/Strictureplasty

"STRICTUREPLASTY

To maintain the principle of preserving bowel length, patients with one or two short segments of strictured small bowel can be treated with strictureplasty. This option is typically reserved for patients who have had previous resections or in whom there is an eminent risk of short bowel syndrome. Although laparoscopic strictureplasty has been described, in our experience it is very technically challenging. We prefer to use a laparoscopic approach to “run” the small bowel and tag segments of stricture using silk suture. Alternatively, we grasp the strictured segment with an atraumatic bowel clamp. We then enlarge the umbilical port incision to a length of 4 to 5 cm and deliver the affected segments of bowel. While protecting the wound with lap pads or a plastic drape, the strictureplasty is performed via the Heineke–Mikulicz or Finney techniques. The bowel is returned to the peritoneal cavity. The incisions are irrigated and closed. We have found that this technique is much simpler, has the benefit of a very small incision, and is much quicker than performing the strictureplasty completely intracorporeally. If multiple strictures are present and it is necessary to perform a Michelassi strictureplasty, this should be approached via laparotomy." http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780224/

Basically they do it laparoscopically with small incisions that allow clamps and other objects to enter the body. If they find the area is too large or there are multiple ones then then they will cut you completely open or use hand assist if needed. Also some strictures are too long for the procedure and may need to be removed.

 

[Sparkle2012]

Amazing. Thank you again for the information.

 

[DreamCreateLive]

Was wondering if there are more patients who have had the bowel sparing procedure done by Dr. Michelassi and if the they could leave a reply as to how they are doing after the procedure. I have had 2 small bowel re-sections, the most recent about 6 years ago in which they left another area of crohn's in me as to not remove the bowel in hope they could treat it with medical therapies. I have had a really rough time since then and now have 3 areas of active crohn's which have stopped responding to cimzia, after in the past failing Remicade and Humira. Thought about trying to get treated with Stellara and have also had doc's recommend going on Methotrexate in conjunction with my Cimzia but i think that just sounds crazy. Some doc's have told me that the scaring and strictures can not be reversed by these drugs.....so why try to push them on me so hard every visit to Dr's office instead of recommending i have a surgery that could greatly improve the quality of my life and better yet spare my bowel?? Seems to me the protocol these dr's are following doesn't work for everyone and is geared towards keeping you on as many drugs as possible whether they work or not and keep you off the operating table which is seen as a last resort. I am going to see Dr. Michelassi for a 2nd time on tuesday as i saw him a year ago when he told me i should have the procedure and that my crohn's was past help with the therapies available as they can not heal my scarring and strictures. I held off then, about 8 months ago, but feel i am now ready for a 3rd and hopefully final surgery so i can get some quality of life back, cuz all i really am doing these days is existing (in pain). Any stories of this procedure, whether good or bad, are welcomed to my ears as there doesn't seem to be too much information from the patients themselves. Also if there are any other threads someone can point me to regarding this bowel sparing procedure please do let me know. Thanks for your time.

 

[Sparkle2012]

I have read that it is a good surgery but I know no one who has had it as I'm not plugged into any other with Crohns aside from this forum which I'm new to. There is a part of me that wonders why they can't develop a "bridge" of some nature for the bowel removed. I read of one person who had bowel transplant and when I contacted him he was on meds to keep his body from rejecting. Have not contacted for outcome and have lost his address. I do know that my pain stopped after stricture surgery. I'm so grateful because my stomach hurt nearly every day for 15 years. I feel normal now aside from the occasional bout of D which is not often. Good luck to you. I will follow this post because I have lost some bowel in my stricture surgery - an "insignificant amount" per the GI. I have a few more years of life left and do not want to get into short bowel issues. Feel better!! Ciao-

 

[DreamCreateLive]

Hey Sparkle! thanks for the support. This is a really great forum on here and i have found so much useful information. All my strictures are below 15cm so apparently they can all have the stricture-plasty done, though some areas may still need to be removed. You pose a very interesting question regarding making a bridge to give people new bowel and im sure that most be something they can either do with transplant or better yet printing the the small bowel and then implanting it, which is now more fiction than sicence fiction.
This seems to be of more worth than the mesenchymal stem cells they have been injecting patients with in the stem cell studies for crohn's disease, one such drug is called Prochymal, as well as stem cell transplants which prove risky. From what i understand they have not had the most success with this...but what do i know. Anyways the last time i had surgery i had an anxiety attack as they were putting me under and i told them to keep me awake so i could tell the surgeon to take out both areas of crohn's instead of leaving me with 6 more painful years of my life. I was filled with a lot of anger when i woke up and in all honesty i still do have quite a bit. The question is now whether to go under the knife or to try another drug and wait around in pain for it to do something. Everytime i read something about methotrexate i hear about patients loosing hair and that is something i am not willing to go thru...as my hair at this point in time is my last bastion of self confidence. ahaha. ridiculous i know. But i dont know if these Dr.s understand the psychological implications of being on these drugs. The other drug is Stellara which is similar to Tysabiri and they are both scary drugs. Stellara seems to be the better choice as it wont turn you into a zombie ie give you PLS.....it can just give you RPLS (reversible zombie syndrome) Eh.. Either way its rough all around. This disease is no joke and i feel for each and every one of you that has gone through this life crushing humbling illness. Sometimes i feel responsible for where i am at currently. Not enough is said for the benefit of diet as far GI's are concerned and in some ways im sure Philly cheese steaks and alcohol did me into a certain degree. Hope there are some more of you out there who had the Michelassi Strictureplasty who can comment on it.....If not i promise all of you that i will give continued updates after i decide whether or not to have the procedure. Also anyone know how long this surgery takes. It will not be done laparoscopically as i have already been operated on before and they will cut me sternum to pelvis. yay! this prospective surgery has me thinking to much about death and dying and just looking for some more hope. Thanks. -Jake

 

[Sparkle2012]

My physician did most of my resection laparoscopically as he specialized in minimally invasive surgery. I had no pain, no pain meds after and a very quick recovery. Perhaps they can do that for strictureplasty also? I don't know. I agree with you that my pasty carby diet is probably what did me in, plus the years of drinking cokes with aspirin for chronic migraines and the ongoing antibiotics for rosacea all coming together to form chronic constipation. I think it all triggered this mess. I don't have a clear diagnosis yet, but all I can say is thank you God that I got so ill that they had to do the resection. I finally have some piece in my life. I don't even mind the 25 lbs I gained with the meds. Much. Good luck, I will keep up with you. There may be a string re that surgery on this forum already. Have you searched it?

 

[DreamCreateLive]

Yes i researched far and wide on the internet searching using many different search terms and while i did find a few threads, it was not as useful as this thread that we are now talking on. There was a promo story done from Dr. Michelassi where they spoke of one of his patients and her success story and there are some great statistics and information published about this type of surgery so that has all helped....Just not as good as talking to and hearing from someone first hand. Wanted to put a bunch of great articles up regarding my past few posts but this thread wont let me until i post over 10 times. oh well. Also, as far as having laproscopic surgery done, it was my understanding this can not be done as they opened me sternum to pelvis in my last two surgeries. Sucks cuz its alot of trauma to the body and a lot to get through. Not looking forward to being helpless....but in many ways i already am, so might as well go for it. Just have to get over the fear.....I used to be fearless when i was younger and just had this unknowing knowing that i would be fine no matter what. Don't like feeling like i have lost control of my life and am now putting it in the hands of surgeons under the bright surgical lights as they dim and i fade out of existence.

 

[Sparkle2012]

Wow I know the feeling. I can remember enjoying a hospital stay because I got so much rest and an excuse to nap all day. Those days are gone. For some reason, this time around I wasn't terrified. I just had some resolve that this was going to end my pain and bring it on. And it did. I expected considerable pain -- they cut me from naval to bikini. Surprisingly that wasn't bad. The thing that hurt me was one of the little lap slits on the right side which I suspect is where most of the work was done...since I had gallbladder removal too. But only some discomfort when I moved there. I really only took tylenol afterwards and then I didn't even take that. However. I had some kind of bowel spasm 3 weeks later that was very painful. I think I injured myself on the doctors flat table when I tried to get up with no help from her. She gave me her hand (why?) and as I pulled, her hand came along with it so she offered no resistance and I found myself on my own unexpectedly using my little sore muscles to sit up. That was very painful and luckily I had pain killer and took it...for 6 days. Other than that it was a breeze. I would research if there is anyone in your area who specializes in "minimally invasive surgery." Who knows? And if we keep talking, you will have your 10 posts and you can start putting up your data. LOL!

 

[Sparkle2012]

:hallo3:I think there should be a special hell for insensitive doctors. Does anyone agree?

 

[seebee]

My brother had his surgery done by Dr. Michelassi about 6 years ago and thank g-d he has been in remission ever since.

 

[DreamCreateLive]

:hallo3:I think there should be a special hell for insensitive doctors. Does anyone agree?

I completely agree with you, and it seems the higher up and more prestigious you go with these top rated Dr.'s, the more insensitivity you find as they operate more like machines and only have enough time with you to bark out a few medicines they want you to be on and regurgitate whatever else they tell all their eleventy billion patients they see a year. Truth is these top doc's dont have time to treat each individual patient as an individual. Anyways, ive found a few great doc's i can rely on and that what matters. You feel them all out till you find the right one. Thanks for all the help and info. Will continue to update as well as fill you in on my story as my situation evolves.

 

[DreamCreateLive]

SeeBee did you brother have the bowel sparing stricture-plasty done? How many areas did he have operated on? I have 3 strictures that will probably need a combination of re-section and stricture-plasty, though i hope i can have all stricture-plasty. I have read that almost all patients have had continued remission since surgery and that crohn's has not come back at the anastamosis which is not seen with bowel re-sections. To me a re-section spells out crohn's almost definitely coming back. Trying to figure out the way i can get the most amount of healthy years out of a single surgery. My past 2 bought me 5-7 years each and really only a few years out of those periods did i experience what i would call good health and quality of life. Thanks for the help! -Jake :ghug: