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Strictureplasty in Crohn's disease.

V W Fazio1, S Galandiuk, D G Jagelman

  • 1Department of Colon and Rectal Surgery, Cleveland Clinic Foundation, Ohio 44195.

Annals of Surgery
|November 1, 1989
PubMed
Summary

Strictureplasty effectively treats fibrotic small bowel strictures in Crohn's disease, relieving obstructive symptoms and improving patient nutrition. This procedure minimizes the need for bowel resection, offering a safe alternative with 0% mortality.

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Area of Science:

  • Gastroenterology
  • Surgical Gastroenterology
  • Inflammatory Bowel Disease

Background:

  • Crohn's disease frequently causes fibrotic small bowel strictures leading to obstruction.
  • Many patients with Crohn's disease strictures have a long disease history and have undergone previous surgeries.
  • Obstructive symptoms are common in patients with fibrotic small bowel strictures.

Purpose of the Study:

  • To evaluate the efficacy and safety of strictureplasty for fibrotic small bowel strictures in Crohn's disease.
  • To assess the impact of strictureplasty on obstructive symptoms, nutritional status, and steroid dependence.
  • To determine the morbidity and mortality rates associated with strictureplasty.

Main Methods:

  • Fifty patients with fibrotic small bowel strictures underwent 225 strictureplasties (Heinecke-Mikulicz and Finney types).

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  • Some patients also had bowel resections for acute inflammation, phlegmon, or fistulae.
  • Patients were followed for 1 to 40 months post-operatively.

    • Main Results:

    • All 42 patients (84%) with obstructive symptoms reported relief and weight gain post-procedure.
    • Steroid doses were reduced, and nutritional parameters (lymphocyte count, albumin) improved.
    • Strictureplasty demonstrated 0% mortality and 16% morbidity, with complications including fistulae and abscesses.

    Conclusions:

    • Strictureplasty is a safe and effective treatment for fibrotic small bowel strictures in Crohn's disease.
    • The procedure significantly alleviates obstructive symptoms and improves nutritional status.
    • Strictureplasty reduces the necessity for extensive bowel resection in selected Crohn's disease patients.