LES PLASTIES INTESTINALES DANS LE TRAITEMENT DES STENOSES DE L'INTESTIN GRELE AU COURS DE LA MALADIE DE CROHN

Strictureplasty is an alternative to extensive and/or multiple small bowel resections in the surgical treatment of Crohn's disease. We here report a series of 22 patients (12 M-10 F - mean age years: 28). All patients had a nonperforative form of Crohn's disease lasting for a mean of 8 years. Nine out of 22 had had previous intestinal resection. A total of 201 stenosis was identified during peroperative examination (mean per patient: 9). Only tight stenoses (diameter < 2 cms) were treated while others were left untouched (n = 22 in 11 patients). Eighty-three stenoses were treated by short strictureplasty and 24 by long strictureplasty using steel thread. One or several resections were simultaneously performed in 15 patients. Mortality was nil. A post operative abscess without loosened suture was drained. The mean follow-up in the 22 patients was 24 months (3-7 years). Clinical and radiological symptoms of stenosis were relieved after strictureplasty. Clinical recurrence occurred in 5 patients among 12 followed-up more than 2 years. Subsequent surgery was required in 4: in one case haemorragic ulceration developed within a long strictureplasty and in 3 others stenosis developed in plasty areas but also in previously healthy areas. In conclusion, strictureplasty is a short and long-term efficient procedure in the treatment of Crohn's disease stenosis. It allows limiting extensive intestinal resection. A more prolonged follow-up is needed in order to evaluate the rate of long-term recurrence and complications that would limit the interest of this technique.