Strictureplasty for Crohn's disease in Japan

Strictureplasty has recently been advocated in the treatment of obstructive strictures of the small bowel in patients with Crohn's disease. In this group study, results for 69 patients with Crohn's disease who underwent strictureplasty were analyzed by sending questionnaires to 13 institutions belonging to the Research Committee of Inflammatory Bowel Disease of the Japanese Ministry of Health and Welfare. No mortality and anastomotic leakage were observed. Strictureplasties of both the Heineke-Mikulicz and Finney varieties were considered to be safe procedures, even though the sutures had to be applied at the slightly inflammed site. The median follow up was 37 months (range, 0-133 months), and 12 patients needed reoperation. The cumulative 3-year operation-free rate was 92.5% and the 5-year rate was 70.3%. The site of the lesion, the strictureplasty procedure, and previous history of small bowel resection did not significantly influence the operation-free intervals. The cumulative 5-year operation-free rate of the group treated with home elemental enteral nutrition (83.3%) was better than that of the non-treated group (65.3%). Strictureplasty was found to be a safe and effective surgical procedure for high-risk patients with Crohn's disease in whom an appropriate length of bowel should be saved.