Strictureplasty and Mechanical Dilation in Strictured Crohn’s Disease

Abstract

The appreciable morbidity and mortality associated with an unusual variant of Crohn’s disease, diffuse jejunoileitis, gave rise to a search for an alternative to resection for the treatment of this severe form of small bowel Crohn’s disease. Emmanoel Lee, working in Oxford in the 1970s was stimulated by the work of Katariya and others in India, who had shown that revision, not resection, of ileal tuberculous strictures was possible with a high rate of healing and relief of the obstruction associated with them (1,2). Lee pioneered the application of the same procedure, strictureplasty, to that form of Crohn’s disease in which short fibrotic strictures of small intestine occur (2). Since that time, the techniques of intestinal strictureplasty have been adopted and used in a large number of centers specializing in inflammatory bowel disease surgery, particularly in Birmingham, UK, under the leadership of Alexander Williams, and in the department of colorectal surgery at the Cleveland Clinic, under the leadership of Victor Fazio. Although questions exist about the exact role of intestinal strictureplasty and its long-term consequences in patients with Crohn’s disease, this procedure has become an accepted mode of therapy for many patients who might otherwise have developed or become vulnerable to a short bowel syndrome. Its role in the treatment of Crohn’s disease is still evolving. In this chapter, we outline the principal indications and contraindications for intestinal strictureplasty, the various techniques used, and their complications. Results of various surgical series, including our own, are presented along with speculation on where strictureplasty may be applied as a therapy for Crohn’s disease in the future. We also will discuss the role of mechanical dilation in the management of intestinal Crohn’s disease. This technique has far less application in the treatment of Crohn’s disease.