Use of Intraoperative Calibration Spheres for Endoluminal Stricture Assessment to Facilitate Heineke-Mikulicz Strictureplasty in Diffuse Stricturing Crohn’s Jejunoileitis

Abstract

Supplemental Digital Content of the Heineke-Mikulicz Strictureplasty technique was published and is reproduced with permission from Lee CHA, Rieder F, Holubar SD. Duodenojejunal bypass and strictureplasty for diffuse small bowel Crohn's disease with a step-by-step visual guide.

Bowel-Preserving Surgery for Diffuse Stricturing Crohn’s Jejunoileitis

“…Strictureplasties are performed on nonpassable strictures, whereas strictures passable with “gentle” pressure are left to surgeon discretion. 11…”

Improvised Techniques for Enhanced Detection of Crohn’s Strictures During Surgery

“…Several techniques have been proposed to improve intraoperative detection of these strictures, including steel calibration balls, intraoperative endoscopy, and marble. [3][4][5][6] We present 2 improvised techniques that have proven effective in detecting subtle strictures in our clinical practice. The first technique involves careful examination of the bowel to identify visible clues indicating the presence of an underlying occult stricture: a narrow band of creeping fat or a small erythematous patch on the antimesenteric surface.…”

“…Several techniques have been proposed to improve intraoperative detection of these strictures, including steel calibration balls, intraoperative endoscopy, and marble. 3–6…”

“…The Foley is inflated to a diameter of 2 cm, following the precedence set by prior similar studies. 3,4 Luminal patency is confirmed by guiding the balloon to the ligament of Treitz and back into the distal bowel via the anastomosis. This method also confirms the patency of the ileocecal valve by passing the balloon into the cecum.…”