Diseases of the Colon & Rectum

, Volume 36, Issue 12, pp 1099–1104 | Cite as

Strictureplasty for ileocolic anastomotic strictures in Crohn's disease

  • Joe J. Tjandra
  • Victor W. Fazio
Original Contributions


PURPOSE: Because of the limited experience, the use of strictureplasty for a strictured ileocolic anastomosis associated with Crohn's disease was reviewed. METHODS: We reviewed 22 patients who had a strictureplasty to treat symptomatic ileocolic anastomotic strictures related to Crohn's disease. The median interval between a previous ileocolic anastomosis and strictureplasty was 2 years (range, 1 to 26 years). The median age was 39 years and there were 15 males and 7 females. The median followup was 2 years. RESULTS: Strictureplasty on a strictured ileocolic anastomosis was either a Heineke-Mikulicz (n=15) or a Finney (n=7) strictureplasty. Fifteen (68 percent) patients needed 47 additional strictureplasties in other sites of the small bowel and 5 (23 percent) patients had synchronous small bowel resection mainly for separate areas of phlegmonous disease. Only five (23 percent) patients did not have a synchronous procedure on the small bowel. There was no mortality or major septic complications. After surgery, relief of obstructive symptoms was noted in all patients. The median weight gain at six months after surgery was 3 kg (range, −5 to +10 kg) and 75 percent of the patients were weaned off steroids. Symptomatic “recurrence” occurred in two (9 percent) patients from new strictures at sites unrelated to previous strictureplasties; only one needed reoperation for recurrence. Patency of the strictureplasty on ileocolic anastomosis in asymptomatic patients was confirmed by small bowel contrast study (n=12) and colonoscopy (n=4). CONCLUSIONS: Strictureplasty preserves small bowel length and may be a viable alternative to repeat ileocolic resection in suitable cases

Key words

Crohn's disease Strictureplasty 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Dalziel TK. Chronic interstitial enteritis. BMJ 1913;2:1068–70.Google Scholar
  2. 2.
    Crohn BB, Ginzburg L, Oppenheimer GD. Regional ileitis: a pathological and clinical entity. JAMA 1932;99:1323–9.Google Scholar
  3. 3.
    Van Spreeuwel JP, Lindeman J, Van Der Wal AM,et al. Morphological and immunohistochemical findings in upper gastrointestinal biopsies of patients with Crohn's disease of the ileum and colon. J Clin Pathol 1982;35:934–40.PubMedGoogle Scholar
  4. 4.
    Lock MR, Fazio VW, Farmer RG,et al. Proximal recurrence and the fate of the rectum following excisional surgery for Crohn's disease of the large bowel. Ann Surg 1981;194:754–60.PubMedGoogle Scholar
  5. 5.
    Lock MR, Farmer RG, Fazio VW,et al. Recurrence and reoperation for Crohn's disease: the role of disease location in prognosis. N Engl J Med 1981;304:1586–8.PubMedGoogle Scholar
  6. 6.
    Fazio VW, Jones IT. Standard surgical treatment of Crohn's disease of the small intestine and ileocolitis. In: Lee EC, Nolan DJ, eds. Surgery of inflammatory bowel disease. Edinburgh: Churchill Livingstone, 1983:462–74.Google Scholar
  7. 7.
    Koch TR, Cave DR, Ford H, Kirsner JB. Crohn's ileitis and ileocolitis: a study of the anatomical distribution of recurrence. Dig Dis Sci 1981;26:528–31.PubMedGoogle Scholar
  8. 8.
    Rutgeerts P, Geboes K, Vantrappen G,et al. Natural history of recurrent Crohn's disease at the ileocolonic anastomosis after curative surgery. Gut 1984;25:665–72.PubMedGoogle Scholar
  9. 9.
    Lee EC, Papaioannou N. Minimal surgery for chronic obstruction in patients with extensive or universal Crohn's disease. Ann R Coll Surg Engl 1982;64:229–33.PubMedGoogle Scholar
  10. 10.
    Alexander-Williams J, Haynes IG. Up-to-date management of small bowel Crohn's disease. Adv Surg 1987;20:245–64.PubMedGoogle Scholar
  11. 11.
    Tjandra JJ, Fazio VW. The benefits of minimal surgery. Can J Gastroenterol 1992;7:254–7.Google Scholar
  12. 12.
    Fazio VW, Galandiuk S, Jagelman DG, Lavery IC. Strictureplasty in Crohn's disease. Ann Surg 1989;210:621–5.PubMedGoogle Scholar
  13. 13.
    Fazio VW, Tjandra JJ, Lavery IC, Church JM, Milsom JW, Oakley JR. Long-term follow-up of strictureplasty in Crohn's disease. Dis Colon Rectum 1993;36:355–6l.PubMedGoogle Scholar
  14. 14.
    Dehn TC, Kettlewell MG, Mortensen NJ, Lee EC, Jewell DP. Ten-year experience of strictureplasty for obstructive Crohn's disease. Br J Surg 1989;76:339–41.PubMedGoogle Scholar
  15. 15.
    Silverman RE, McLeod RS, Cohen Z. Strictureplasty in Crohn's disease. Can J Surg 1989;32:19–22.PubMedGoogle Scholar
  16. 16.
    Pritchard TJ, Schoetz DJ, Caushaj FP,et al. Strictureplasty of the small bowel in patients with Crohn's disease. Arch Surg 1990;125:715–7.PubMedGoogle Scholar
  17. 17.
    Kendall GP, Hawley PR, Nicholls RJ, Lennerd-Jones JE. Strictureplasty: a good operation for small bowel Crohn's disease? Dis Colon Rectum 1986;29:312–6.PubMedGoogle Scholar
  18. 18.
    Sharif H, Alexander-Williams J. Strictureplasty for ileocolic anastomotic strictures in Crohn's disease. Int J Colorectal Dis 1991;6:214–6.PubMedGoogle Scholar
  19. 19.
    Tjandra JJ, Fazio VW. Strictureplasty in Crohn's disease. In: Cameron JL, ed. Current surgical therapy. 4th ed. Philadelphia: BC Decker, 1992:108–13.Google Scholar
  20. 20.
    Lee EC. Surgery in Crohn's disease. In: Pena AS, Weterman IT, Booth CC, Strober W, eds. Developments in gastroenterology. Vol I. The Hague: Martinus Nijhof, 1980.Google Scholar


  1. 1a.
    Fazio VW, Tjandra JJ, Lavery IC, Church JM, Milsom JW, Oakley JR. Long-term follow-up of strictureplasty in Crohn's disease. Dis Colon Rectum 1993;36:355–61.PubMedGoogle Scholar
  2. 2a.
    Sayan J, Wilson DA, Allan A, Andrews H, Alexander-Williams J. Recurrence after strictureplasty or resection for Crohn's disease. Br J Surg 1989:76:335–8.PubMedGoogle Scholar
  3. 3a.
    Tjandra JJ, Fazio VW. Strictureplasty for ileocolic anastomotic strictures in Crohn's disease. Dis Colon Rectum 1993;36:1099–1104.PubMedGoogle Scholar
  4. 4a.
    Alexander-Williams J, Haynes I. Conservative operations for Crohn's disease of the small bowel. World J Surg 1985;9:945–51.PubMedGoogle Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1993

Authors and Affiliations

  • Joe J. Tjandra
    • 1
  • Victor W. Fazio
    • 1
  1. 1.Department of Colorectal SurgeonsCleveland Clinic FoundationCleveland

Personalised recommendations