Relationship of the Number of Crohn's Strictures and Strictureplasties to Postoperative Recurrence

Alexander J. Greenstein, Linda P. Zhang, Aaron T. Miller, Elliot Yung, Bernardino C. Branco, David B. Sachar, Adrian J. Greenstein

Research output: Contribution to journalArticlepeer-review

27 Scopus citations

Abstract

Background: Strictureplasty is well established as a safe and effective surgical therapy for Crohn's disease (CD). Yet, postoperative recurrence after strictureplasty remains a problem for CD patients, and associated risk factors are still uncertain. The goal of this study was to examine the relationship between recurrence and the number of strictures (NSX) and strictureplasties (NSXP). Study Design: The authors' prospectively created database was used to retrospectively identify patients who had undergone strictureplasty between 1984 and 2004. Recurrence was defined as reoperation, and rates were compared based on the NSX and NSXP using Kaplan-Meier curves. Cox regression analyses were used to evaluate the relationship between both NSX and NSXP and recurrence after adjusting for potential confounders. Results: There were 339 strictureplasties performed in 88 patients at initial operation. The 5-year reoperation rates were 14% for patients with ≤ 8 strictures compared with 31% for those with > 8 strictures (p = 0.01). Five-year reoperation rates were 14% for patients with ≤ 4 strictureplasties compared with 33% for those with > 4 strictureplasties (p < 0.01). In multivariate regression of NSX and NSXP as continuous variables, both were independently associated with recurrence (p ≤ 0.02), with a 7% increase in recurrence for each additional stricture and 23% increase in recurrence for each additional strictureplasty. Conclusions: These data suggest that both the NSX and NSXP are associated with CD recurrence and may be used as prognostic indicators for CD.

Original languageEnglish
Pages (from-to)1065-1070
Number of pages6
JournalJournal of the American College of Surgeons
Volume208
Issue number6
DOIs
StatePublished - Jun 2009

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