Strictureplasty versus bowel resection for the surgical management of fibrostenotic Crohn’s disease: a systematic review and meta-analysis

Butt, Waqas; Ryan, Éanna J; Boland, Michael R.; McCarthy, E; Omorogbe, Joseph; Hazel, Karl; Bass, Gary Alan; Neary, Paul; Kavanagh, Dara; McNamara, Deirdre; O’Riordan, J M

doi:10.1007/s00384-020-03507-z

Cited by 21 publications

(12 citation statements)

References 70 publications

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“…Surgical recurrence was higher for bowel resection (29.4%) vs. strictureplasty (39.7%; p = 0.002). No difference was observed for medical recurrence for bowel resection (12.4%) vs. strictureplasty (18.0%; p = 0.82) and also for overall morbidity between bowel resection (18.1%) vs. strictureplasty (10.7%; p = 0.65) [39,40].…”

Section: Figure 12 the Michelassi Technique (1): A1 -Anastomosis Of Two Stenotic Segments B1 -The Edges Of Bowel Can Be Trimmed To Allow mentioning

confidence: 91%

“…Bowel resection is associated with lower recurrence rate (25.1%) compared to structureplasty (35.9%; p = 0.04). Recurrence-free survival was longer for bowel resection vs. strictureplasty (p = 0.02) [39,40].…”

Section: Figure 12 the Michelassi Technique (1): A1 -Anastomosis Of Two Stenotic Segments B1 -The Edges Of Bowel Can Be Trimmed To Allow mentioning

confidence: 99%

“…Resection is associated to lower rates of recurrence. Patients submitted do strictureplasty alone may present a higher rate of disease recurrence [24]. The patient should have a small length stricture and no prior resection (Table 4).…”

Section: Resectionmentioning

confidence: 99%

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Current Elective Surgical Treatment of Inflammatory Bowel Disease

Oliveira¹,

Boiocchi²,

Bafutto³

et al. 2023

Current Topics in Colorectal Surgery

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The incidence of inflammatory bowel disease (IBD) is increasing world-wide and most patient will require some surgical treatment once in life. IBD surgical patients are a challenge to surgeons. Main goals of surgical treatment are (1) to preserve the small bowel integrity because many resections may lead the patient to a small bowel short syndrome and (2) restore normal function as they have absorption disturbances. IBD patients may present mal-nutrition status and/or immunosuppression at the time of surgery. Types of surgery range from a simple plasty in Crohn disease to a total proctocolectomy in Ulcerative Colitis. For Crohn disease most procedures avoid resection and use diseased segments to prevent disabsorption. Herein we describe the most currently used techniques to treat IBD patients, when to indicate surgery and how to prepare them to less outcomes. Patients with Crohn disease with high risk for short bowel syndrome and intestinal failure should be submitted to Strictureplasty otherwise, Bowel Resection is the favored surgical technique for the management of fibrostenotic. Bowel Resection is associated with lower recurrence rate and longer recurrence-free survival.

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Section: Figure 12 the Michelassi Technique (1): A1 -Anastomosis Of Two Stenotic Segments B1 -The Edges Of Bowel Can Be Trimmed To Allow mentioning

confidence: 91%

Section: Figure 12 the Michelassi Technique (1): A1 -Anastomosis Of Two Stenotic Segments B1 -The Edges Of Bowel Can Be Trimmed To Allow mentioning

confidence: 99%

See 1 more Smart Citation

Current Elective Surgical Treatment of Inflammatory Bowel Disease

Oliveira¹,

Boiocchi²,

Bafutto³

et al. 2023

Current Topics in Colorectal Surgery

View full text Add to dashboard Cite

show abstract

“…Compared with bowel resection, strictureplasty preserves intestinal length and minimizes the risk of short bowel syndrome, but has a higher risk of recurrence and its relapse‐free survival is significantly lower. Moreover, accompanying complications such as fistulae, abscesses, dysplasia and cancer are contraindications for strictureplasty, and its success largely depends on the operator's expertise 98,99 . A retrospective study in 2020 found that the 5‐year reoperation rates of bowel resection alone, strictureplasty alone and a combination of both procedures were 22%, 30% and 42%, respectively 100 .…”

Section: Treatmentmentioning

confidence: 99%

“…Therefore, bowel resection is the preferred surgical technique for fibrostenotic CD with lower incidences of postoperative infection, anastomotic leakage and reintervention due to the minimally invasive techniques used in bowel resection 101 . Instead, strictureplasty is more suitable for CD patients with strictures at a high risk of short bowel syndrome and intestinal failure 98 …”

Section: Treatmentmentioning

confidence: 99%

Intestinal stricture in Crohn's disease: A 2020 update

Lin

Qiu

Zhuang

et al. 2021

J of Digest Diseases

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Crohn's disease (CD) is a chronic and relapsing–remitting inflammatory disorder of the gastrointestinal tract. Approximately 70% of patients inevitably develop fibrosis‐associated intestinal stricture after 10 years of CD diagnosis, which seriously affects their quality of life. Current therapies play limited role in preventing or reversing the process of fibrosis and no specific anti‐fibrotic therapy is yet available. Nearly half of patients thus have no alternative but to receive surgery. The potential mechanisms of intestinal fibrosis remain poorly understood; extracellular matrix remodeling, aberrant immune response, intestinal microbiome imbalance and creeping fat might exert fundamental influences on the multiple physiological and pathophysiological processes. Recently, the emerging new diagnostic techniques have markedly promoted an accurate assessment of intestinal stricture by distinguishing fibrosis from inflammation, which is crucial for guiding treatment and predicting prognosis. In this review, we concisely summarized the key studies published in the year 2020 covering pathogenesis, diagnostic modalities, and therapeutic strategy of intestinal stricture. A comprehensive and timely review of the updated researches in intestinal stricture could provide insight to further elucidate its pathogenesis and identify novel drug targets with anti‐fibrotic potentiality.

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Essential updates 2020/2021: Colorectal diseases (benign)—Current topics in the surgical and medical treatment of benign colorectal diseases

Shinmoto

Miyamoto

Yoshida

et al. 2022

Annals of Gastroent Surgery

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The development of new drugs for inflammatory bowel disease (IBD) is remarkable, and treatment strategies using multiple agents and various techniques are required; however, the treatment strategy is likely to be complex. Therefore, appropriate evaluation of traditional surgical treatment strategies and accurate knowledge of the efficacy and limitations of novel treatments are required. Total infectious complications were found to be associated with the use of corticosteroids and anti‐tumor necrosis factor‐α agents, but not with immunomodulators, anti‐integrin agents, and 5‐aminosalicylic acid. Regarding surgical procedures for IBD, conceived anastomosis methods, including Kono‐S for Crohn's disease stenosis, are associated with better outcomes than conventional techniques. Autologous cell transplantation for Crohn's fistulae has been shown to have a favorable outcome. Diverticulitis is increasing and will be treated more frequently in the future. Risk factors for the incidence of diverticulitis and differences in pathogenesis according to right or left side diverticulitis have been reported. Antibiotic therapy may be omitted for uncomplicated diverticulitis. Moreover, regarding surgical procedures, both bowel resection and anastomosis are associated with favorable short‐term outcomes, higher stoma closure rate, and superior medical economy compared to Hartmann's procedure. Risk factors for recurrence after diverticulitis surgery may provide better postoperative follow‐up. In this review, we explore the current topics of colorectal benign diseases, focusing on IBD and diverticulitis, based on clinical trials and meta‐analyses from 2020‐2021. This review consolidates the available knowledge and improves the quality of surgical procedures and perioperative management for IBD and diverticulitis.

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Strictureplasty versus bowel resection for the surgical management of fibrostenotic Crohn’s disease: a systematic review and meta-analysis

Cited by 21 publications

References 70 publications

Current Elective Surgical Treatment of Inflammatory Bowel Disease

Current Elective Surgical Treatment of Inflammatory Bowel Disease

Intestinal stricture in Crohn's disease: A 2020 update

Essential updates 2020/2021: Colorectal diseases (benign)—Current topics in the surgical and medical treatment of benign colorectal diseases

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