How safe is strictureplasty in the management of Crohn's disease?

Strictureplasty is a well-accepted technique in the management of selected patients with Crohn's disease. To determine the safety and optimal clinical setting for performing strictureplasty, perioperative complications and long-term outcomes need to be analyzed.

We retrospectively reviewed the charts of 162 patients (87 men, 75 women) with Crohn's disease who underwent strictureplasty between June 1984 and July 1994. Medical and surgical history, including medications and laboratory data, intraoperative findings, perioperative complications, and long-term follow-up data were recorded.

These patients underwent 698 strictureplasties (Heineke-Mikulicz procedures, 617; Finney procedures, 81). Median hospital stay was 8 days. Perioperative septic complications were noted in 8 patients (5%); however, reoperation for sepsis was needed only in 5 patients. Five percent of patients developed prolonged ileus after strictureplasty. Symptomatic improvement after strictureplasty was achieved in 98% of patients. Restricture or new stricture or perforative disease was seen in 5% and 17% of patients, respectively, during a 42-month median follow-up period.

Our findings show that strictureplasty is a good surgical option for stenosing small-bowel Crohn's disease, particularly in patients with multiple obstruction and in those vulnerable to short-bowel syndrome. Perioperative complications are few, and long-term results are gratifying.