Background
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, 8]
Endoscopic approaches to stricturotomy and strictureplasty have also been developed for treating strictures associated with Crohn disease. [9, 10] A study by Sampietro et al found laparoscopic strictureplasty to be feasible and to have low morbidity in patients with complicated Crohn disease. [11]
Indications
Indications for strictureplasty include the following:
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Prior resection of more than 100 cm of small bowel
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Rapid recurrence of Crohn disease with obstructive symptoms
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Obstructing, fibrotic small-bowel stricture without associated sepsis
Contraindications
Contraindications for strictureplasty include the following:
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Stricture close to a planned anastomotic site
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Multiple strictures within a short segment
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Any stricture with evidence of dysplasia or malignancy
Outcomes
A 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, 12]
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Heineke-Mikulicz strictureplasty.
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Finney strictureplasty.
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Jaboulay strictureplasty.
