Strictureplasty For Crohn's Disease Research Articles

Short- and long-term outcomes of strictureplasty for obstructive Crohn's disease.

To evaluate the frequency and outcome of strictureplasty in the era of biologicals and to compare patients operated on by strictureplasty alone, resection alone or a combination of both. A retrospective review of all patients undergoing strictureplasty for obstructing jejunoileal Crohn's disease (CD) in Oxford between 2004 and 2016 was conducted. For comparison, a cohort of CD patients with resection only during 2009 and 2010 was included. In all, 225 strictureplasties were performed during 85 operations, 37 of them in isolation and 48 with simultaneous resection. Another 82 procedures involved resection only; these patients had shorter disease duration, fewer previous operations and longer bowel preoperatively. The frequency of strictureplasty procedures did not alter during the study period and was similar to that in the preceding 25 years. There was no postoperative mortality. One patient required re-laparotomy for a leak after strictureplasty. None developed cancer. The 5-year reoperation rate for recurrent obstruction was 22% (95% CI 12-39) for resection alone, 30% (17-52) for strictureplasty alone and 42% (27-61) for strictureplasty and resection (log rank P=0.038). Young age was a risk factor for surgical recurrence (log rank P=0.006). The use of strictureplasty in CD has not changed significantly since the widespread introduction of biologicals. Surgical morbidity remains low. The risk of recurrent strictures is high and young age is a risk factor. In this study, strictureplasty alone was associated with a lower rate of reoperation compared with strictureplasty with resection.

Long-term Results of the Side-to-side Isoperistaltic Strictureplasty in Crohn Disease: 25-year Follow-up and Outcomes.

Review the long-term outcomes of the side-to-side isoperistaltic strictureplasty (SSIS) and its effects on bowel preservation in Crohn disease (CD). The first SSIS was performed 25 years ago as an alternative to resection in the treatment of extensive fibrostenosing jejuno-ileal CD. Prospective study (January 1992-December 2016) of all patients with a SSIS performed by the authors. Long-term outcomes were evaluated radiographically, endoscopically, and histopathologically. Sixty patients [14.4% of patients with jejuno-ileal bowel CD; 31 females; median age 36 (12-69) years] underwent 61 SSIS's for partial intestinal obstruction. Median length of preserved small bowel was 50 (20-148) cm. Associated strictureplasties and bowel resection were performed in 44% and 80%, respectively. Postoperative mortality occurred in 1 (PE on POD#8) and postoperative morbidity in 7 (12%). There were no sutureline dehiscences. SSIS resulted in resolution of preoperative symptoms in all. After a median follow-up of 11 years (range 1 mo-25 yrs), symptomatic recurrence was observed in 61%: 15 patients at the SSIS and 19 away from it (2 cases unclear location; 7 patients with >1 recurrence). Of 15 recurrences at SSIS's, 11 required surgical treatment (revision or strictureplasty in 6, SSIS removal in 5). Fifty-one patients (86%) maintain the original SSIS to date. SSIS is a safe, effective, and durable strictureplasty in patients with extensive fibrostenosing CD of the small bowel. Half the surgical recurrences on SSIS can be managed by subsequent revision or strictureplasty. The majority of patients maintain the original SSIS after a median follow-up of 11 years.

Long-Term Outcomes and Patency Rate of Stricture Plasty for Crohn Disease

Long-Term Outcomes and Patency Rate of Stricture Plasty for Crohn Disease

Long-term Results of Side-to-Side Isoperistaltic Strictureplasty for Crohn Disease.

Long-term Results of Side-to-Side Isoperistaltic Strictureplasty for Crohn Disease.

Strictureplasty

Over the past three decades, strictureplasty for Crohn disease with fibrostenotic stricture has been shown to be both efficacious and safe. Although segmental resection remains the standard of care for obstruction secondary to Crohn stricture, strictureplasty should be considered for patients with a history of prior resections who are at increased risk for short bowel syndrome with additional resections. There is ample evidence to support both conventional and nonconventional strictureplasty techniques for both jejunoileal and ileocolonic anastomotic strictures. The role of strictureplasty for both duodenal and colonic disease, as well as the risk of malignant transformation at strictureplasty sites, is yet to be determined.

Side to side isoperistaltic strictureplasty in Crohn disease: Report of two cases

Side to side isoperistaltic strictureplasty in Crohn disease: Report of two cases