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Results of surgical treatment for jejunal Crohn’s disease: choice between resection, strictureplasty, and combined treatment

Langenbeck's Archives of Surgery volume 402, pages 1071–1078 (2017)Cite this article

Abstract

Purpose

The jejunum is a relatively uncommon localization of Crohn’s disease (CD) compared to the terminal ileum or the large bowel. The type of surgery and the short and long-term results after surgery have not been extensively investigated. A review of patients who underwent surgery for jejunal CD in our center was examined.

Methods

Between 1986 and 2011, 110 patients underwent surgery for jejunal CD. Thirty patients (27.3 %) were surgically treated with resection, 29 patients (26.4 %) with one or more strictureplasties, and 51 patients (46.3 %) with both a resection and one or more strictureplasties.

Results

There was no statistical difference in terms of short-term postoperative complications between patients operated with three different options (p = 0.72). Patients were followed up for a period ranging from 2 to 18 years (mean 11 years). During this period, 42 patients had no CD recurrence, 11 patients had medical recurrences only, while 57 patients had surgical recurrences, too. There was no statistical difference in terms of medical and surgical recurrence between the three types of surgical procedures employed (p = 0.24) and between smokers and non-smokers. The recurrent CD was prevalently treated with strictureplasty.

Conclusions

The most frequently employed surgery for the treatment of jejunal CD is a combined type of treatment, i.e., resection of the most affected tract and strictureplasty of the residual strictures. This approach does not imply an increased risk of postoperative complications and recurrence and can reduce the risk of the short bowel syndrome.

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Abbreviations

CD:

Crohn’s disease

TPN:

Total parenteral nutrition

PPN:

Peripheral parenteral nutrition

H-M:

Heinecke-Mikulicz

SSIS:

Side-to-side isoperistaltic strictureplasty

UGI:

Upper gastrointestinal

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Acknowledgments

Prof. Maria Rosaria Buri, Professional Translator/Aiic Conference Interpreter, University of Salento, for English language editing ( http://www.mariarosariaburi.it ).

Author contributions

All authors contributed equally to this work. Adriana Focardi and Carmela Di Martino collected the data; Giovanni Alemanno, Francesco Giudici, Carmela Di Martino, and Francesco Tonelli analyzed data and wrote the manuscript; Francesco Giudici and Giovanni Alemanno supervised all the manuscript. Giorgio Gronchi performed statistical analysis.

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Authors and Affiliations

  1. Department of Surgery and Translational Medicine, University of Florence Medical School, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy

    Francesco Tonelli, Carmela Di Martino, Adriana Focardi, Giorgio Gronchi & Francesco Giudici

  2. General, Emergency and Minimally Invasive Surgery Unit, Careggi University Hospital, 50134, Florence, Italy

    Giovanni Alemanno

Authors
  1. Francesco Tonelli
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  2. Giovanni Alemanno
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  3. Carmela Di Martino
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  4. Adriana Focardi
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  5. Giorgio Gronchi
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  6. Francesco Giudici
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Correspondence to Francesco Tonelli.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its subsequent amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Tonelli, F., Alemanno, G., Di Martino, C. et al. Results of surgical treatment for jejunal Crohn’s disease: choice between resection, strictureplasty, and combined treatment. Langenbecks Arch Surg 402, 1071–1078 (2017). https://doi.org/10.1007/s00423-016-1497-x

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  • DOI: https://doi.org/10.1007/s00423-016-1497-x

Keywords

  • Jejunal Crohn’s disease
  • Strictureplasty
  • Resection
  • IBD
  • Recurrence