Principle indications for strictureplasty are multiple strictures over large length of bowel, previous resections, short bowel syndrome and strictures associated with

phlegmon or fistula [34, 31, 42]. Contraindications include preoperative malnutrition (albumin < 2 g/dL), perforation, multiple strictures over short length of bowel, stricture short distant from area of resection and bleeding from planned strictureplasty site [34, 31, 42]. Several strictureplasty techniques have been described and the choice depends on the length of the stricture [34]. Short strictures are treated with Heineke-Mikulicz strictureplasty. A longitudinal enterotomy is realized over the stricture on the antimesenteric border of the bowel and extended 1 to 2 cm onto either side of normal bowel. The enterotomy can be realized using Alectinib datasheet bistury or cautery. Ulixertinib Then, the enterotomy is closed transversally with a interrupted, sieromuscolar, absorbable suture. The closure should

be performed in one or two layers and must be tension-free. The Finney strictureplasty is used for strictures of intermediate length. First of all, a stay suture is localized in the midpoint of the stricture. The enterotomy is performed throught the stricture, again extending 1 to 2 cm onto normal bowel. Then strictured segment is folded onto itself to realize a “”U”" and another stay suture is localized in the normal side of bowel to keep the “”U”" in place. The posterior edges are sutured in a continuous way using an absorbable suture. In the end, enough the anterior edges are closed with a interrupted non absorbable suture. In 1996, Michelassi introduced the side-to-side isoperistaltic strictureplasty for long strictures, usually greater than 20 to 25 cm, and multiple strictures over a limited area [43]. In this technique, the sctrictured bowel is lifted

up and his mesentery is divided at the midpoint. Then the diseased bowel is divided between atraumatic bowel clamps at the midpoint of the stricture. The proximal end of the cut bowel is brought over the distal end in a side-to-side way. The two loops are approached with a single-layer, interrupted, non absorbable suture. Then enterotomy is realized longitudinally for the length of the stricture. The ends of bowel are spatulated to avoid blind ends. Next, a inner layer of running, full-thickness, absorbable suture is placed and continued anteriorly. This anterior layer is then followed by a layer of interrupted, non absorbable, sieromuscolar suture. Markedly thickened bowel loops, thickened and friable mesentery, inflammatory phlegoms, fistula, abscesses and adhesions from previous surgery represent a surgical challenge to the laparoscopic approach.