Comparison of Conventional and Nonconventional Strictureplasties in Crohn’s Disease

Abstract

The nonconventional strictureplasty techniques were noninferior to the conventional strictureplasty procedures with respect to all prespecified outcomes.

Montreal classification of patient operated for Crohn's disease and identification of surgical recurrence predictors

“…In this cohort, few patients underwent plasty of stenosis, always Heine-type Mickulicz, in segmental stenoses 12 . This is because most stenoses were long, resulting in the realization of enterectomies or the need for more extensive plasties, type Jaboulay or Michelassi 12 , which are not used in our service. Moreover, as most of the patients underwent emergency surgery, resection allowed the confirmation of CD by histological analysis of the specimen in patients without prior diagnosis.…”

Multidisciplinary Management of Gastrointestinal Fibrotic Stenosis in Crohn’s Disease

“…In their meta-analysis, von Roon et al found that the relative risk of colon cancer alone was 2.59 (p \ 0.01) in 6,418 patients with no study heterogeneity, and the crude incidence was 4.97 per 10,000 patient year in 9,656 patients [137]. Stricturoplasty has also been associated with a risk of stricture relapse in 30-35 % of patients at 4-8 years [138,139]. Stricturoplasty is a safe alternative to resection in jejuno-ileal CD, including ileocolonic recurrence, with similar short-term and long-term results [140][141][142].…”

“…The median incidence of perioperative complication following stricturoplasty is 10-15 % and that of major complications is around 5 % (i.e., events requiring repeated laparotomy) [4,138,148]. The efficacy of stricturoplasty is evaluated thanks to the medial surgical recurrence rate which is 24 % after a median follow-up of 46.6 months [4].…”

“…Indications for stricturoplasty include the presence of multiple fibrotic strictures over a long small bowel segment, previous large small bowel resection (i.e., more than 100 cm), short bowel syndrome, strictures without phlegmon or septic fistula, duodenal strictures, anastomotic strictures (especially ileorectal or ileocolic sites), rapid recurrence of disease with obstruction, and growth retardation [133,138,149,156]. Contraindications for stricturoplasty have also been reported and include stricture with abscess or phlegmon, perforation with diffuse peritonitis, suspected carcinoma at the stricture site, poor nutritional status (i.e., a serum albumin level less than 20 g/l), stricture located near an area of resection, and multiple strictures over short lengths of bowel [2,149].…”

Post-operative recurrence in Crohn's disease. Critical analysis of potential risk factors. An update

“…These Authors report that no increased incidence of recurrence was found after anastomosis performed on affected tissue, thus concluding that the incidence of POR is independent from the resection. 1,146,147 Various other authors reported higher rates of relapse in patients in whom the margins of section are microscopically affected by the disease. 33,41,62,65,145 This leads to the conclusion that the treatment of CD consist simply in the removal of the intestinal tract macroscopically ill.…”