Strictureplasty
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Strictures are focally narrowed segments of intestine that often result in bowel obstruction. A number of factors can lead to the development of strictures, such as inflammatory bowel disease, malignancy, infection, and prior operations.
Crohn disease is an inflammatory disorder in which transmural inflammation can occur anywhere in the gastrointestinal (GI) tract, and this often results in the formation of strictures. Several studies have reported that a high proportion of patients with Crohn disease require surgical intervention during their lifetime, with most studies citing numbers in the range of 70-90%. [1, 2, 3, 4]
Today, strictureplasty is a well-established surgical treatment for patients with Crohn disease. [5] It is a safe and effective procedure that preserves bowel length and averts metabolic sequelae associated with short-gut syndrome in patients with symptomatic obstructive Crohn disease. For Crohn disease of the jejunum, strictureplasty may be combined with resection of the affected segment. [6]
According to data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), strictureplasty to treat Crohn disease is becoming less common; however, when the procedure is performed, postoperative rates of infectious complications and reoperation remain low. [7]
Indications for strictureplasty include the following:
Contraindications for strictureplasty include the following:
One meta-analysis by Yamamoto et al examined 1112 patients who underwent surgical treatment for strictures and found strictureplasty to be a safe and effective procedure for Crohn disease of the jejunum and ileum. [1] Although recurrence is a frequent problem in patients with obstructive Crohn disease, numerous studies have found that in most patients who underwent strictureplasties, recurrence occurred at nonstrictureplasty sites. [1, 8]
Yamamoto T, Fazio VW, Tekkis PP. Safety and efficacy of strictureplasty for Crohn’s disease: a systematic review and meta-analysis. Dis Colon Rectum. 2007 Nov. 50(11):1968-86. [Medline].
Greenstein AJ, Zhang LP, Miller AT, Yung E, Branco BC, Sachar DB, et al. Relationship of the number of Crohn’s strictures and strictureplasties to postoperative recurrence. J Am Coll Surg. 2009 Jun. 208(6):1065-70. [Medline].
Jobanputra S, Weiss EG. Strictureplasty. Clin Colon Rectal Surg. 2007 Nov. 20(4):294-302. [Medline]. [Full Text].
Lee EC, Papaioannou N. Minimal surgery for chronic obstruction in patients with extensive or universal Crohn’s disease. Ann R Coll Surg Engl. 1982 Jul. 64(4):229-33. [Medline]. [Full Text].
Yeo H, Michelassi F. Strictureplasty in Crohn’s disease. Cameron JL, Cameron AM, eds. Current Surgical Therapy. 12th ed. Philadelphia: Elsevier; 2017. 117-21.
Tonelli F, Alemanno G, Di Martino C, Focardi A, Gronchi G, Giudici F. Results of surgical treatment for jejunal Crohn’s disease: choice between resection, strictureplasty, and combined treatment. Langenbecks Arch Surg. 2016 Aug 17. [Medline].
Geltzeiler CB, Young JI, Diggs BS, Keyashian K, Deveney K, Lu KC, et al. Strictureplasty for Treatment of Crohn’s Disease: an ACS-NSQIP Database Analysis. J Gastrointest Surg. 2015 May. 19 (5):905-10. [Medline].
Dietz DW, Laureti S, Strong SA, Hull TL, Church J, Remzi FH, et al. Safety and longterm efficacy of strictureplasty in 314 patients with obstructing small bowel Crohn’s disease. J Am Coll Surg. 2001 Mar. 192(3):330-7; discussion 337-8. [Medline].
Reese GE, Purkayastha S, Tilney HS, von Roon A, Yamamoto T, Tekkis PP. Strictureplasty vs resection in small bowel Crohn’s disease: an evaluation of short-term outcomes and recurrence. Colorectal Dis. 2007 Oct. 9(8):686-94. [Medline].
Maggiori L, Michelassi F. How I do it: Side-to-side isoperistaltic strictureplasty for extensive Crohn’s disease. J Gastrointest Surg. 2012 Oct. 16 (10):1976-80. [Medline].
de Buck van Overstraeten A, Wolthuis AM, D’Hoore A. Modified side-to-side isoperistaltic strictureplasty over the ileocaecal valve for the surgical treatment of terminal ileal Crohn’s disease: the ultimate bowel sparing technique?. Colorectal Dis. 2016 Aug. 18 (8):O311-3. [Medline].
Fazi M, Giudici F, Luceri C, Pronestì M, Tonelli F. Long-term Results and Recurrence-Related Risk Factors for Crohn Disease in Patients Undergoing Side-to-Side Isoperistaltic Strictureplasty. JAMA Surg. 2016 May 1. 151 (5):452-60. [Medline]. [Full Text].
Ambe R, Campbell L, Cagir B. A comprehensive review of strictureplasty techniques in Crohn’s disease: types, indications, comparisons, and safety. J Gastrointest Surg. 2012 Jan. 16 (1):209-17. [Medline].
Mustafa W Aman, MD Resident Physician, Department of Surgery, University of Arizona College of Medicine
Mustafa W Aman, MD is a member of the following medical societies: American College of Surgeons, American Medical Association
Disclosure: Nothing to disclose.
Vassiliki Liana Tsikitis, MD, MCR, FACS, FASCRS Associate Professor of Surgery, Medical Director of Digestive Health Center, Department of Surgery, Division of Gastrointestinal and General Surgery, Oregon Health and Science University School of Medicine
Vassiliki Liana Tsikitis, MD, MCR, FACS, FASCRS is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Society of Clinical Oncology, American Society of Colon and Rectal Surgeons, Association for Academic Surgery, European Society of Coloproctology, International Society for Digestive Surgery, International Society of Surgery, Pacific Coast Surgical Association, Society for Surgery of the Alimentary Tract, SWOG
Disclosure: Nothing to disclose.
Kurt E Roberts, MD Assistant Professor, Section of Surgical Gastroenterology, Department of Surgery, Director, Surgical Endoscopy, Associate Director, Surgical Skills and Simulation Center and Surgical Clerkship, Yale University School of Medicine
Kurt E Roberts, MD is a member of the following medical societies: American College of Surgeons, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons
Disclosure: Nothing to disclose.
Strictureplasty
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