Strictureplasty in Diffuse Crohn's Jejunoileitis

Abstract

Strictureplasty is a safe and durable alternative to resection in diffuse Crohn's jejunoileitis. Patients with a short duration of disease and short interval since last surgery are at higher risk for accelerated recurrence. Patients with diffuse jejunoileitis do not appear to be at higher risk for recurrence than patients with more limited Crohn's disease.

Safety and Efficacy of Strictureplasty for Crohn's Disease: A Systematic Review and Meta-Analysis

“…Eight studies examining risk factors for recurrence after jejunoileal strictureplasty were analyzed (Table 5). 29,31,36,42,62,64,65,69 Younger age, 36,62 short duration of disease, 36,69 and short interval since previous resection 36,64,69 were significant risk factors for the recurrence. In contrast, smoking, steroid use, nutritional status, and number, site, or length of strictureplasties did not affect the recurrence rate.…”

“…Eight studies investigating risk factors for complications after jejunoileal strictureplasty were selected from the literature (Table 3). 31,36,42,54,57,62,63,69 Preoperative hypoalbuminemia, 54 unscheduled (emergency) operations, 31 the presence of an intra-abdominal abscess with peritoneal contamination, 62 low hemoglobin level, 63 older age at operation, 36 and preoperative weight loss 36 were significant risk factors. In contrast, steroid use, synchronous bowel resection, and number, site, or length of strictureplasties were not significant risk factors.…”

“…36,62,69,95 A previous meta-analysis 65 found that Finney strictureplasty has a lower recurrence rate compared with Heineke-Mikulicz strictureplasty. However, as the authors stated, their outcome was largely a statistical phenomenon.…”

“…31,36,54,62,63 In contrast, steroid use, synchronous bowel resection, and number, site, or length of strictureplasties were not significant factors. 31,36,42,54,57,62,63,69 There remain several questions about the long-term results of jejunoileal strictureplasty. In the majority of the previous studies, the follow-up duration was still Wound infection: 3 Others: 4 SXPL = strictureplasty; SB = small bowel; RE = resection; H-M = Heineke-Mikulicz; N/A = not available.…”

Endoscopic Evaluation of Surgically Altered Bowel in Patients With Inflammatory Bowel Diseases

“…However, judicious selection of surgical modality including stricturoplasty can give durable outcomes. 38,44,45 Stricturoplasty provides a bowel preserving option for patients without the complications of blind loop, marginal ulcers, and bile reflux associated with bypass surgery. There are various types of stricturoplasty techniques for CD or non-CD strictures.…”