A Surgery for Crohn's That Saves the Intestine

Surgeon Dr. Fabrizio Michelassi's "side-to-side isoperistaltic stricturoplasty" procedure can alleviate the pain of Crohn's disease while sparing the intestine and safeguarding patients from developing malnutrition. The procedure is a welcome alternative to traditional methods which rely on removing part of the intestine and repeating the procedure each time the disease spreads.

For those unfamiliar with Crohn's, the disease attacks and inflames the intestine, making it difficult for food to pass. Patients must often restrict their diet to soft or even liquid meals yet still endure bouts of abdominal pain and nausea.

With the "side-to-side isoperistaltic stricturoplasty," Dr. Michelassi makes a small incision in the patient's stomach and draws out the diseased part of the intestine – coiling it on the patient's stomach like a garden hose, or, from another perspective, drawing the lengths "side to side." From here, he cuts the two lengths of intestine horizontally and, in a long and intricate process, sews the edges together to make a wider length of intestine from the two narrower ones. "Food can now pass and not an inch of intestine is lost," says Dr. Michelassi.

What causes Crohn's is largely unknown and there is no cure. The disease is most common in North America and Europe, but seldom seen in Africa, and its prevalence in Asia and South America is increasing.

Most researchers believe that a certain genetic disposition plus an environmental "trigger" cause Crohn's to surface. Supporting this theory is evidence that immigrants to the western world begin to develop Crohn's at the rate of the native population.

Dr. Michelassi is chairman and Lewis Atterbury Stimson Professor of Surgery at Weill Cornell Medical College and surgeon-in-chief at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.