Current methods of bowel-sparing surgery in Crohn’s disease

Abstract

The recurrent nature of Crohn’s disease may require repeated surgical procedures and, potentially, intestinal resections over time. Up to 30% of patients require at least 2 surgical procedures in their lifetime.1,2 Patients subjected to multiple intestinal resections are at risk of diarrhea, chronic malnutrition, electrolyte derangements, vitamin B12 and folate deficiencies, chronic anemia, and short gut syndrome severe enough to require temporary or permanent parenteral nutrition.3 In an effort to minimize the occurrence of short gut syndrome, several bowel-sparing surgical techniques (i.e., strictureplasty) have been described in the last 20 years. They all address Crohn’s-related complication without, as the name implies, sacrificing bowel.4–6 Data accrued during the course of the past 2 decades suggest that, with appropriate selection of patients, bowel-sparing surgical techniques are safe and effective.7–9 Morbidity is low, and reoperative rates seem to be comparable to those obtained after resection and anastomosis. In addition, several recent studies have provided compelling evidence that active Crohn’s disease regresses to quiescent disease at the site of a strictureplasty.10–13 These observations provide further support for bowel-sparing procedures in Crohn’s disease and offer hope that regression from active to quiescent disease may translate in return of intestinal absorptive function. This chapter reviews current indications and contraindications, preoperative evaluation, operative techniques, postoperative complications, and long-term results of strictureplasty in Crohn’s disease.