Step‐by‐step demonstration of Hotokezaka strictureplasty for Crohn's disease: A video vignette

In patients with Crohn's disease, predominantly fibrotic strictures often cause obstruction and require surgery [1-5]. Resection, although widely adopted, is associated with high recurrence rates and may lead to short-bowel syndrome after repeated procedures [1]. Strictureplasty offers a bowel-preserving alternative. The Heineke–Mikulicz [1] and Finney [1] techniques are effective for short segments, while the side-to-side isoperistaltic strictureplasty [2] suits long-segment disease. In some patients with long-segment and multifocal disease, bowel resection and strictureplasties can be combined to preserve bowel length. A side-to-side-to-end strictureplasty may be useful when diseased proximal bowel and disease-free distal bowel remain after necessary resection. We describe a modified side-to-side-to-end strictureplasty [1] (Figure 1) to manage complex cases requiring limited resection while maximising preservation. The operation begins with laparoscopic exploration via a supraumbilical Hasson port, plus two 5 mm trocars in the left iliac fossa and flank. The ileocaecal region is mobilised to the hepatic flexure with careful dissection from the duodenum. The supraumbilical incision is enlarged and fitted with a wound protector for safe extracorporeal reconstruction. As illustrated in Figure 1, after resection of 25 cm of non-salvageable ileocaecal bowel, the proximal diseased loop is divided in half with its mesentery and aligned isoperistaltically with the distal segment. Mesenteric reinforcement is performed with a rolling barbed suture. A mechanical side-to-side strictureplasty is created with four sequential 75 mm tri-stapler firings, forming the main reconstruction. A Heineke–Mikulicz stricturoplasty is performed at the inlet. The distal end is anastomosed to the healthy distal colon in a side-to-side-to-end configuration, completed with interrupted full-thickness absorbable sutures and reinforced with seromuscular stitches (Video 1). This approach may reduce early restenosis and supports long-term functional outcomes in cases where a bowel resection is needed. Clemente Junior Nappi: Third surgeon; conceptualization; writing – original draft; writing – review and editing; video editing. Marc Martí-Gallostra: First surgeon; conceptualization; validation; supervision; resources; visualization; investigation; methodology. Miquel Kraft: Second surgeon; Conceptualization; investigation; methodology; validation; visualization; supervision. Gianluca Pellino: Conceptualization; investigation; methodology; validation; visualization; supervision. Eloy Espín-Basany: Supervision; conceptualization; investigation; funding acquisition; validation; methodology; visualization. The authors have nothing to report. None declared. This study was conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. For this type of study, formal ethical approval was not required. Written informed consent for the surgical procedure and for publication of anonymized clinical data and video material was obtained from the patient. The data that support the findings of this study are available from the corresponding author upon reasonable request.