Description of new “bowel-sparing” techniques for long strictures of crohn's disease

doi:10.1016/S0002-9610(97)00003-2

The American Journal of Surgery

Volume 173, Issue 6, June 1997, Pages 509-512

https://doi.org/10.1016/S0002-9610(97)00003-2 Get rights and content

In the period of January 1993 to December 1995 we operated on 55 patients with various complications of Crohn's disease. In properly selected cases, obstructive complications of Crohn's disease can be treated effectively by strictureplasty. Long strictures, even if a narrow lumen is still present, are commonly managed by resection, as classic strictureplasties cannot be done; also Finney strictureplasty seems inadequate, as it creates a blind loop that favors bacterial overgrowth and fecal stasis. Three original “sparing bowel” surgical approaches are proposed as possible alternative in the treatment of long stricture in Crohn's disease. We perform side-to-side ileoileal plasty whenever we are faced with severe narrowing of a long segment of small bowel (>10 cm);side-to-side ileocolic plasty whenever very severe disease with narrowing of ileocaecal valve is present;and ileocaecal plasty when terminal ileitis involves the very distal end of the small bowel, but sparing or only minimally affecting the ileocaecal valve. The above-mentioned procedures are described in detail and the clinical outcomes related to the first 8-patient series of our institution are presented.

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Mesentery thickening and enlarged lymphnodes are typical findings of Crohn's disease (CD), but their role is unknown. Aim of the present study was to evaluate their prevalence and significance on postoperative complications and long-term surgical recurrence after CD surgery.
1272 consecutive, unselected patients were retrospectively reviewed, divided into 4 groups based on the presence or absence of a thickened mesentery and enlarged lymphnodes, and stratified for primary or recurrent surgical procedure. In all patients but those treated with strictureplasty the mesentery and lymphnodes were removed. Patients’ characteristics, peri-operative findings, and long-term recurrence were compared by univariate and multivariate analysis.
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Citation Excerpt :
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A total of 865 jejunoileal segments underwent 318 small bowel resections and 367 strictureplasties (either classic or nonconventional). There were no deaths; the complication rate was 5.6%, and the cumulative 10-year recurrence rate was 35%. None of the prognostic factors were correlated with postoperative complications. Younger age, an upper jejunoileal location, stricturing behavior, and small-bowel wall thickening 12 months after surgery showed hazard ratios of 2.4 (95% confidence interval [CI], 1–5.4; P = .03), 2.5 (95% CI, 1.3–4.7; P = .004), 2.2 (95% CI, 1.1–4.1; P = .01), and 4.5 (95% CI, 2.3–8.6; P = .000), respectively. Immunomodulator therapy failed to reduce long-term surgical recurrence.
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View full text

Description of new “bowel-sparing” techniques for long strictures of crohn's disease

Am J Surg

Crohn's disease in Stockholm county. 1955–1974. A study of epidemiology, results of surgical treratment and long term prognosis

Acta Chir Scand

The early and late results of surgical treatment for Crohn's disease

British J Surg

Factors affecting recurrence following resection for Crohn's disease

Dis Colon Rectum

Long term follow-up of strictureplasty in Crohn's disease

Dis Col Rectum

Minimal surgery for chronic obstruction in patients with extensive or universal Crohn's disease

Ann R Coll Surg Eng

Strategies for preserving intestinal length in the short bowel syndrome

Dis Colon Rectum