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Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Long-term efficacy of strictureplasty for Crohn's disease
Motoi Uchino1, Hiroki Ikeuchi, Hiroki Matsuoka
1Department of Surgery, Division of Lower Gastroenterology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan.
Purpose:
Strictureplasty (SP) is an established surgical option for the management of obstructive Crohn's disease (CD) to avoid an extended resection. This study reviewed this department's extensive experience with SP as treatment for obstructive CD to clarify its long-term efficacy and recurrence.
Methods:
The medical records of 526 patients who underwent abdominal surgery for CD were retrospectively reviewed. The patients were divided into two surgical groups: those with or without SP. Surgical recurrences were limited to the site of the previous anastomosis or SP.
Results:
Four hundred and thirty-five of the patients underwent surgery without SP and 91 with SP, performed in a total of 199 sites. Heineke-Mikulicz procedures and concomitant bowel resections were performed in 85.7% and 95.6%, respectively, of the patients in the With SP group. Postoperative septic complications included intra-abdominal abscesses in 2 patients (2.2%). The site-specific cumulative rate of reoperation at the previous surgical site after 10 years was 7.0% in the previous SP site and 18.0% in the previous anastomosis, which was significantly different (P < 0.01).
Conclusions:
Strictureplasty is a safe and effective method for obstructive CD, and should be considered when feasible. The recurrence rate was lower in the present study than that reported in Western countries.
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