Long-term follow-up of strictureplasty in Crohn's disease

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 non perforative form of Crohn's disease lasting for a mean of 8 years. Nine out of 22 had previous intestinal resections. A total of 201 stenosis was identified during per-operative examination (mean per patient: 9). Only tight stenoses (diameter < 2 cm) were treated while others were left untouched. 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 abcess without loosened suture was drained. The mean follow-up in the 22 patients was 36 months (range: 12 to 96). Belief of obstructive symptoms was achieved in all patients. Symptomatic recurrence occurred in 9 patients (40%) and 5 (22%) needed reoperation. In one case haemorragic ulceration developed within a long strictureplasty and in 4 others stenosis developed in plasty areas but also in previous healthy areas. Thus strictureplasty is intended not to replace resection but rather to serve as a useful adjunct to the existing surgical options in the treatment of Crohn's disease, especially when short bowel syndrome is a consideration.