STRICTUREPLASTY IN THE SURGICAL TREATMENT OF COMPLICATED CROHN’S DISEASE.

Abstract

Introduction: Crohn’s disease is a panintestinal chronic inflammatory condition. Its remitting-relapsing behaviour may require in the single patient repeated surgeries, with the aim of resolving the complications of the disease. The awereness that surgery cannot resolve the disease has led, in the last years, to the development of new “conservative surgical techniques”, which preserve as much of the intestinal tissue as possible. These techniques are minimal resection and strictureplasty (SP). Aim of the study was to perform a prospective analysis of the long-term outcome of SP in a consecutive series of patients undergoing surgery for complicated Crohn’s Disease at the Division of general surgery, L. Sacco University Hospital, Milano, Italia.

Methods and Results: During the period of October 1992 to June 2002, 286 patients underwent surgical procedures for jejunoileal Crohn’s disease. 116 of them underwent SP resulting in a total of 217 procedures, of which: 111 Heineke-Mikulicz SP (51.2%), 36 ileoileal side-to-side SP (16.6%), 40 ileoceacal SP (18.4%) and the remaining 30 ileocolic SP (13.8%), as previously described by A.M. Taschieri. Fiftyone of the patients (23.5%) had concomitantly a minimal bowel resection. Postoperative mortality was nil, while in 3 cases (2.59%) repeated surgery was necessary due to postsurgical complications. Time-to-event estimates were performed using the Kaplan-Meier function.

Conclusions: mortality, morbidity, and long-term results in this population of patients who underwent SP are encouraging and in line with reports in the international literature. It is suggested that SP, together with minimal bowel resections, may be considered as first line surgical therapy in patients with Crohn’s Disease.