Side-to-side isoperistaltic strictureplasty

(Panel A) The mesentery of the intestinal loop is divided at its midpoint, and the small bowel is severed between atraumatic intestinal clamps. The proximal intestinal loop is moved over the distal one in a side-to-side fashion such that stenotic areas of one loop are placed adjacent to dilated areas of the other loop. The two loops are approximated by a layer of interrupted nonabsorbable sutures.
(Panel B) A longitudinal enterotomy is performed on both loops, and the intestinal ends are spatulated (tapered) to avoid blind stumps.
(Panel C) The enterotomies are closed with an internal (posterior) running, full-thickness absorbable suture that is continued anteriorly and finished as a running Connell suture. This closure is reinforced by another layer of interrupted seromuscular nonabsorbable sutures (not shown).