Non-conventional Versus Conventional Strictureplasties for Crohn’s Disease. A Systematic Review and Meta-analysis of Treatment Outcomes

Abstract

Background Strictureplasties (SXP) represents an alternative to bowel resection in Crohn’s disease (CD). Over the years, there has been growing interest in the role of non-conventional SXP for the treatment of extensive CD. A systematic review was performed on complications and recurrence of conventional and non-conventional SXP. Methods The available literature was screened according to the PRISMA statement until June 2020. Results were categorized into three groups: studies reporting on conventional SXPs; studies with a mixed cohort of conventional and non-conventional SXPs (% non-conventional SXPs ≤15%), and studies reporting on non-conventional SXPs. Considered endpoints were postoperative complications, and overall and SXP site-specific surgical recurrence. Random effect meta-analysis and meta-regression were used to obtain and compare combined estimates between groups. Results A total of 26 studies for a total of 1839 patients with CD were included. The pooled postoperative complication rate was 15.5% (95% CI 11.2%-20.3%), 7.4% (95% CI 0.2%-22.9%), and 19.2% (95% CI 5-39.6%). The rate of septic complications was 4% (95% CI 2.2%-6.2%), 1.9% (95% CI 0.4%-4.3%), and 4.2% (95% CI 0.9%-9.8%). Cumulative overall surgical recurrence was 27.5% (95% CI 18.5%-37.6%), 13.2% (95% CI 8.6%-18.7%), and 18.1% (95% CI 6.8%-33.3%) and SXP site-specific surgical recurrence was 13.2% (95% CI 6.9%-21.2%), 8.3% (95% CI 1.6-19.3%), and 8.8% (95% CI 2.2%-19%). Formal comparison between the groups revealed no differences. Conclusion Non-conventional SXP did not differ to conventional SXP with respect to safety and long-term recurrence. Consistent heterogeneity was observed and partially limits the conclusion of this study.

Intestinal strictures in Crohn’s disease: a 2021 update

“…Results showed a comparatively low rate of postoperative complications (15.5% versus 19.2%) and surgical recurrence (26.9% versus 18.2%) for the two types of surgical therapies during median follow-up periods of 65.3 and 96.3 months, respectively, suggesting that both techniques were feasible. 93 Considering the significant heterogeneity among the included studies, the conclusion should however be further verified. For the first time, a prospective cohort study investigated the safety and feasibility of conventional or nonconventional SXP in combination with laparoscopy for complicated CD.…”

“…CD patients refractory to medical or endoscopic treatment, or with complex complications (strictures, abscesses, and fistulae), would eventually need surgical interventions such as strictureplasty (SXP) and bowel resection. 1 , 92 Bislenghi et al 93 conducted a meta-analysis including 26 studies aiming to explore the efficacy of conventional (short and intermediate procedures such as Heineke–Mikulicz and Finney) and nonconventional (long entero-enterostomies such as Michelassi) SXP. Results showed a comparatively low rate of postoperative complications (15.5% versus 19.2%) and surgical recurrence (26.9% versus 18.2%) for the two types of surgical therapies during median follow-up periods of 65.3 and 96.3 months, respectively, suggesting that both techniques were feasible.…”

Perforating and nonperforating indications in repeated surgeries for Crohn’s disease

“…Surgical intervention is necessary for patients with acute perforation, internal fistulae, peritoneal abscess, intestinal obstruction, toxic dilatation, hemorrhage, and/or failed response to medical therapy[ 4 ]. Surgery is effective in removing the lesions and relieving symptoms; however, surgical resection is not curative for CD, and postoperative recurrence is common.…”