Reoperative rates for Crohn's disease following strictureplasty

Özüner, Gökhan; Fazio, Victor W.; Lavery, Ian C.; Milsom, Jeffrey W.; Strong, Scott A.

doi:10.1007/bf02055108

Cited by 91 publications

(51 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…One hundred and fifteen dilations (range: [1][2][3][4][5][6][7][8] times/person) were performed in the 40 patients. 4 Long-term avoidance of surgery rate (Fig. 2) Seven patients were operated on because of frequent recurrences or for intractable fistulas, one because of a perforation after the second dilation and one because of massive bleeding unrelated to the dilation procedures (Table IV).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Long‐Term Outcome of Endoscopic Balloon Dilation in Obstructive Gastrointestinal Crohn′s Disease: A Prospective Long‐Term Study

Matsui

Ikeda

Tsuda

et al. 1999

Diagnostic and Therapeutic Endoscopy

View full text Add to dashboard Cite

Background The short-and long-term results of balloon dilation therapy in Crohn's patients with non-anastomotic obstructive gastrointestinal lesions are investigated.Materials and methods Fifty-five patients with Crohn's disease who had obstructive gastrointestinal lesions were treated prospectively by endoscopic balloon dilation.Short-term results Eight of the initial dilations were unsuccessful giving no symptomatic relief (14.5%).Long-term results The subjects of the long-term prognosis were 40 cases followed up for more than 6 months (average 37 months) and their strictures were non-anastomotic in more than half (59%). Avoidance of surgery, was possible in 31 of 40 patients (78%). Surgery was avoided in 92%, 81% and 77% of patients after one, two, and three years, respectively (Kaplan-Meier's method). There was no difference in long-term outcome between anastomotic strictures and strictures in the absence of prior surgery.Conclusion Our results suggest that, (1) strictures in the absence of prior surgery might be treated in this way as well as anastomotic strictures; (2) if followed for a prolonged time period, more than 70% of patients, who have undergone balloon dilation for obstructive gastrointestinal Crohn's disease, may be able to avoid surgery. of these underwent balloon dilation in our institute.All the procedures were performed by study members (T.M., S.T., K.Y. and S.S.) in a uniform procedure.Patients Thirty-two of the 55 patients were male. Age at the onset of gastrointestinal symptoms was ranged from 15 to 36 years (average 26.6). The diagnosis of Crohn's disease was confirmed endoscopically, radiographically or histologically. Before obstructive symptoms occurred, their disease had been followed for an average of 7.9 years (range 0.8-10.0). They were classified into 14 small intestinal (6 gastroduodenal), 34 ileocolitis, and 7 colitis type cases. At the time of dilation 32 (58%) had previously undergone surgery. Six patients had gastroduodenal stenoses and 49 patients had ileocolic stenoses. At the time of dilation 45 patients had mild to severe obstructive symptoms and 10 did not have obvious obstructive symptoms but had severe strictures which an endoscope was not able to pass through. These 10 patients had been recieving nutritional therapy (total parenteral nutrition or elemental diet) for active diseases for several weeks and were on nil by mouth. After disease activity had settled down to remission stage (CDAI < 150), colonoscopic evaluation revealed severe stenosis in these patients. They did not have obstructive symptoms because they had not ingest an ordinary diet yet. Seven of the ten asymptomatic patients turned out to be symptomatic during follow-up when on a regular diet. Indications for DilationIndications for balloon dilation were as follows:(1) patients who had strictures in gastroduodenal lesions or ileocolonic lesions, (2) the activity of the disease was quiescent (CDAI < 150, in 48) or not highly active (150 < CDAI < 250, in 7), (3) their general condition was not extremely p...

show abstract

Section: Resultsmentioning

confidence: 99%

“…Patients typically present with symptoms of upper and lower intestinal obstruction. In these patients, usual medical therapy has little effect in curing obstruction [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Long‐Term Outcome of Endoscopic Balloon Dilation in Obstructive Gastrointestinal Crohn′s Disease: A Prospective Long‐Term Study

Matsui

Ikeda

Tsuda

et al. 1999

Diagnostic and Therapeutic Endoscopy

View full text Add to dashboard Cite

show abstract

“…Controversy exists on the recurrence rate after strictureplasty and resection. 16,[18][19][20][21][22][23] Several invesigators 18,19 have reported no significant differences in rates of recurrence after strictureplasty versus resection. No significant difference is also reported in the recurrence rate after strictureplasty alone and strictureplasty plus resection.…”

Section: Discussionmentioning

confidence: 99%

“…No significant difference is also reported in the recurrence rate after strictureplasty alone and strictureplasty plus resection. 16,20 However, metaanalysis of 7 studies performed by Reese et al 21 showed that patients who underwent resection had significantly longer recurrence-free survival than did those who underwent strictureplasty alone. In the present study, duration between previous operation and recurrence was significantly shorter in patients who underwent strictureplasty than in patients who underwent resection and anastomosis.…”

Section: Discussionmentioning

confidence: 99%

Difference in Recurrence Patterns Between Anastomosis and Strictureplasty After Surgical Treatment for Crohn Disease

Hayakawa

Hotokezaka

Ikeda

et al. 2012

International Surgery

View full text Add to dashboard Cite

This study aimed to investigate whether the initial indication for surgery or type of surgery (strictureplasty or resection) performed determines recurrence patterns in patients with Crohn disease. Recurrence patterns of 41 patients (31 patients: only resection and anastomosis of the intestine, and 10 patients: strictureplasty with/without resection and anastomosis) who underwent operation for recurrent Crohn disease (June 2002–December 2010) were evaluated. Strictureplasty for nonperforating disease was performed at 17 sites, and reoperation was required at 11 sites (10 sites for nonperforating disease and 1 site for perforating disease). There was a significant difference in the recurrence pattern in patients who underwent resection and anastomosis (P < 0.01) and in patients who underwent strictureplasty with resection and anastomosis (P < 0.05) between sites at which resection and anastomosis was performed for nonperforating and for perforating disease. Initial indication for surgery, but not the type of surgery, appeared to determine recurrence patterns.

show abstract

“…Although the data in the literature seem to indicate no difference between conservative and conventional surgery in terms of both early perioperative results and long-term recurrence rates [21, 22], few data are currently available concerning SPs and intestinal anastomoses specifically performed on active diseased segments. The aim of this study was to evaluate the perioperative complications, long-term surgical recurrence, and analyze the factors thought to influence them in a consecutive series of prospectively followed patients.…”

Section: Introductionmentioning

confidence: 99%

Early Perioperative Results and Surgical Recurrence after Strictureplasty and Miniresection for Complicated Crohn’s Disease

Sampietro

Cristaldi²,

Porretta³

et al. 2000

Dig Surg

View full text Add to dashboard Cite

Background/Aims: Strictureplasty (SP) or miniresective ‘bowel-sparing’ techniques (MR) can prevent the risk of intestinal stomia and short bowel syndrome in patients affected by Crohn’s disease (CD). The aim of this study was to analyze the perioperative morbidity and mortality in 104 of 138 consecutive patients treated for CD complications using bowel-sparing techniques. We also considered the factors that may be related to the risk of perioperative complications and the long-term outcome. Methods: One hundred and four patients were treated with SP and/or MR and then included in a prospectively maintained database. The factors claimed to influence perioperative complications were analyzed using Fisher’s exact test for categorical observations and the Mann-Whitney U test for continuous variables. A multivariate analysis, using logistic regression, and a long-term time-to-event analysis using the Kaplan-Meier function, were also performed. Results: Perioperative mortality was nil. In relation to the 6 postoperative complications (5.8%), 4 patients underwent minimal bowel resection (MR), 1 a MR with SP, and 1 SP alone. Three of these patients (2.9%) needed reoperation for septic complications, and 3 (2.9%) were treated as outpatients for enterocutaneous fistulas. A correlation (p < 0.05) was found between low serum hemoglobin levels and postoperative complications at univariate and multivariate analyses. The 5-year surgical recurrence-free rate was 75% overall, 73% for patients treated with SP, 78% with MR, and 77% with MR + SP. Conclusions: Postoperative complications are not related to conservative or miniresective surgery even when active disease is present at the resection margins or the site of SP. The higher risk reported for patients with low serum hemoglobin and hematocrit levels suggests that surgeons should consider using preoperative iron and vitamin support, parenteral nutrition and erythropoietin therapy, when necessary, in those cases. Our postoperative morbidity, mortality and long-term surgical recurrence rate results support the efficacy and safety of SP and MR surgery in the treatment of complicated CD.

show abstract

Reoperative rates for Crohn's disease following strictureplasty

Abstract: Strictureplasty is a safe and effective procedure for Crohn's disease in selected patients. Reoperative rates are comparable with resective surgery, and most recurrences occur at new sites.

Cited by 91 publications

References 14 publications

Long‐Term Outcome of Endoscopic Balloon Dilation in Obstructive Gastrointestinal Crohn′s Disease: A Prospective Long‐Term Study

Long‐Term Outcome of Endoscopic Balloon Dilation in Obstructive Gastrointestinal Crohn′s Disease: A Prospective Long‐Term Study

Difference in Recurrence Patterns Between Anastomosis and Strictureplasty After Surgical Treatment for Crohn Disease

Early Perioperative Results and Surgical Recurrence after Strictureplasty and Miniresection for Complicated Crohn’s Disease

Contact Info

Product

Resources

About