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Current methods of bowel-sparing surgery in Crohn’s disease

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Abstract

The recurrent nature of Crohn’s disease may require repeated surgical procedures and, potentially, intestinal resections over time. Up to 30% of patients require at least 2 surgical procedures in their lifetime.1,2 Patients subjected to multiple intestinal resections are at risk of diarrhea, chronic malnutrition, electrolyte derangements, vitamin B12 and folate deficiencies, chronic anemia, and short gut syndrome severe enough to require temporary or permanent parenteral nutrition.3 In an effort to minimize the occurrence of short gut syndrome, several bowel-sparing surgical techniques (i.e., strictureplasty) have been described in the last 20 years. They all address Crohn’s-related complication without, as the name implies, sacrificing bowel.4–6 Data accrued during the course of the past 2 decades suggest that, with appropriate selection of patients, bowel-sparing surgical techniques are safe and effective.7–9 Morbidity is low, and reoperative rates seem to be comparable to those obtained after resection and anastomosis. In addition, several recent studies have provided compelling evidence that active Crohn’s disease regresses to quiescent disease at the site of a strictureplasty.10–13 These observations provide further support for bowel-sparing procedures in Crohn’s disease and offer hope that regression from active to quiescent disease may translate in return of intestinal absorptive function. This chapter reviews current indications and contraindications, preoperative evaluation, operative techniques, postoperative complications, and long-term results of strictureplasty in Crohn’s disease.

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Authors and Affiliations

  1. Section of General Surgery, Department of Surgery, The University of Chicago, Chicago, Illinois

    Alessandro Fichera, Roger D. Hurst & Fabrizio Michelassi

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  1. Alessandro Fichera
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  2. Roger D. Hurst
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  3. Fabrizio Michelassi
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Reprinted fromAdvances in Surgery, Volume 37, Fichera A, Hurst RD, Michelassi F, Current methods of bowel-sparing surgery in Crohn’s desease, 231–251, copyright 2003 Mosby, with permission from Elsevier.

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Fichera, A., Hurst, R.D. & Michelassi, F. Current methods of bowel-sparing surgery in Crohn’s disease. J Gastroenterol 40 (Suppl 16), 40–50 (2005). https://doi.org/10.1007/BF02990578

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