Abstract
Introduction
Crohn’s disease is one of the chronic inflammatory diseases of the gastrointestinal tract that is often complicated by stricture formation with resulting obstructive symptoms. The technical repertoire of strictureplasty procedures has increased over the years in an effort to manage the diverse presentations of this condition while limiting the need for bowel resection. In this comprehensive review, we describe, compare, categorize, and appraise the strengths and weaknesses of 15 unique strictureplasty techniques.
Methods
To identify all unique strictureplasty procedures, a Medline search utilizing “Crohn’s disease,” “surgical therapy,” “strictureplasty,” “enteroenterostomy,” “Heineke–Mikulicz,” and “side-to-side isoperistaltic” strictureplasty as medical subject headings was completed. PubMed, Ovid, Embase, and Cochrane database searches were conducted. Relevant articles between 1980 to December 2010 were reviewed. We initially selected 58 articles, but only 18 introduced novel surgical procedures related to 15 types of strictureplasty in Crohn’s disease.
Results
We identified 15 types of strictureplasty techniques. These were categorized into three main groups. The revised nomenclature will facilitate the reader to understand the differences and utility of each technique. These groups include the Heineke–Mikulicz-like strictureplasties, the intermediate procedures, and the enteroenterostomies. Heineke–Mikulicz strictureplasty was the most frequently used technique.
Conclusion
Various techniques of strictureplasty have been reported in the published literature. Strictureplasty has been shown to be a safe and efficacious technique that is comparable to bowel resection for stricturing Crohn’s disease. This technique spares bowel length and puts the Crohn’s disease patient at a lower risk of developing short bowel syndrome with repeated resections.
Similar content being viewed by others
References
Katariya RN, Sood S, et al. Stricture-plasty for tubercular strictures of the gastro-intestinal tract. Br. J. Surg. 1977; 64: 496–498
Lee EC, Papaioannou N. Minimal surgery for chronic obstruction in patients with extensive or universal Crohn’s disease. Ann. R. Coll. Surg. Eng. 1982; 64: 229–233
Milsom JW. Strictureplasty and mechanical dilation in strictured Crohn’s disease. In: Michelassi F, Milsom JW (eds). Operative strategies in inflammatory bowel disease. New York: Springer; 1999:259–267
Gaetini A, DeSimone M, Resegotti A. Our experience with strictureplasty in the surgical treatment of Crohn’s disease. Hepato-gastroenterol , 1989; 36: 511–515
Sasaki I, et al. Extended strictureplasty for multiple short skipped strictures of Crohn’s disease. Dis. Colon Rectum, 1996; 39: 342–344
Tjandra JJ, Fazio VW. Strictureplasty for ileocolic anastomotic strictures in Crohn’s disease. Dis. Colon Rectum. 1993; 36: 1099–103
Taschieri AM, et al. Description of new “bowel-sparing” techniques for long strictures of Crohn’s disease. Am. J. Surg. 1997; 173: 509–512
Sampietro GM, et al. A prospective longitudinal study of nonconventional strictureplasty in Crohn’s disease. J. Am. Coll. Surg. 2004; 199: 8–22
Gordon PH and Nivatvongs S. Crohn’s disease. Principles and practice of surgery for the colon, rectum and anus, 3rd edition. St. Louis: Quality Medical; 1999:856–860.
Fazio VW, Tjandra JJ. Strictureplasty for Crohn’s disease with multiple long strictures. Dis. Colon Rectum, 1993; 36; 71–72
Selvaggi F. et al. A new type of strictureplasty for the treatment of multiple long stenosis in Crohn's disease. Inflamm Bowel Dis. 2007; 13: 641–642
Poggioli G. et al. Conservative surgical management of terminal ileitis; side-to-side enterocolic anastomosis. Dis. Colon Rectum. 1997; 40: 234–239.
Tonelli F, Fazi M, Di Martino C. Ileocecal strictureplasty for Crohn’s disease: long-term results and comparison with ileocecal resection. World J. Surg. 2010; 34:2860–2866
Michelassi F: Side-to-side isoperistaltic strictureplasty for multiple Crohn’s strictures. Dis Colon Rectum. 1996; 39: 345–349
Hurst RD, Michelassi F. Strictureplasty for Crohn’s disease: techniques and long-term results. World J. Surg. 1998; 22: 359–363
Poggioli G. et al. A new model of strictureplasty for multiple and long stenoses in Crohn’s ileitis: side-to-side diseased to disease-free anastomosis. Dis. Colon Rectum. 2003; 46: 127–130
di Abriola FG, De Angelis P, Dall’Oglio L, Di Lorenzo M. Strictureplasty: an alternative approach in long segment bowel stenosis Crohn’s disease. J. Pediatr. Surg. 2003; 38: 814–818
Sasaki I. et al. New reconstructive procedure after intestinal resection for Crohn’s Disease: modified side-to-side isoperistaltic anastomosis with double Heineke–Mikulicz procedure. Dis. Colon Rectum 2004; 47: 940–943
Hotokezaka M, Ikeda T, Uchiyama S, Hayakawa S, Tsuchiya K, Chijiiwa K. Side-to-side-to-end strictureplasty for Crohn’s disease. Dis. Colon Rectum. 2009; 52: 1882–1886
Tonelli F et al. Strictureplasty in Crohn’s disease: surgical option. Dis. Colon Rectum. 2000; 43: 920–926
P. Roy and D. Kumar. Strictureplasty: British Journal of Surgery 2004; 91: 1428–1437
Laureti S. and Fazio VW. Obstruction in Crohn’s disease: strictureplasty versus resection. Current Treatment Options in Gastroenterology 2000; 3: 191–201.
Jobanputra S. and Weiss E. Strictureplasty. Clin Colon Rectal Surg. 2007; 20: 294–302.
Roy P, Kumar D. Strictureplasty for active Crohn’s disease. Int J Colorectal Dis, 2006; 21: 427–432
Tichansky D, Cagir B, Yoo E, Marcus S, Fry R. Strictureplasty for Crohn’s disease: meta-analysis. Dis Colon Rectum 2000; 43: 911–919.
Yamamoto T, Fazio V, Tekkis P. Safety and efficacy of strictureplasty for Crohn’s disease: a systemic review and meta-analysis. Dis Col Rectum, 2007; 50: 1968–1986.
Spencer M, Nelson H, Wolff B, Dozois R. Strictureplasty for obstructive Crohn’s disease: the Mayo experience. Mayo Clin Proc, 1994; 69: 33–36.
Scarpa M, Ruffolo C, et al. Intestinal surgery for Crohn’s disease: predictors of recovery, quality of life, and costs. J Gastrointest Surg, 2009; 13: 2128–2135
Binion D, Theriot K, Shidham S, et al. Clinical factors contributing to rapid reoperation for Crohn’s disease patients undergoing resection and/or strictureplasty. J Gastrointest Surg, 2007; 11: 1692–1698
Froehlich F, Juillerat P et al. Fibrostenotic Crohn’s disease. Digestion 2007;76: 113–115
Dietz D, Laureti S, Fazio V et al. Safety and long-term efficacy of strictureplasty in 314 patients with obstructing small bowel Crohn’s disease. J Am Coll Surg. 2001; 192: 330–337
Baba S and Nakai K. Strictureplasty for Crohn’s disease in Japan. J. Gastroenterol, 1995; 30: 135–138
Fichera A, et al. Patterns and operative treatment of recurrent Crohn’s disease: a prospective longitudinal study. J. Surg. 2006; 140:649–654
T. Yamamoto and M. Keighley. Long-term results of strictureplasty without synchronous resection for jejunoileal Crohn’s disease. Scand J Gastroenterology 1999; 2: 180–184.
Futami K, Arima S. Role of strictureplasty in surgical treatment of Crohn’s disease. J. Gastroenterol 2005; 40: 35–39.
Reese G, Purkayastha S, et al. Strictureplasty vs. resection in small bowel Crohn’s disease: an evaluation of short-term outcomes and recurrence. Meta-analysis. Colorectal Disease, 2006; 9: 686–694.
Fernhead N, Chowdhury R, et al. Long-term follow-up of strictureplasty for Crohn’s disease. British Journal of Surgery, 2006; 93: 475–482.
Broering D, et al. Quality of life after surgical therapy of small bowel stenosis in Crohn’s disease. Digestive Surgery, 2001; 18: 124–130.
Dasari B, Maxwell R, Gardiner K. Assessment of complications following strictureplasty for small bowel Crohn’s disease. Irish Journal of Medical Science, 2009; 179: 201-205.
Tonelli F, Fedi M, Paroli M, Fazi M. Indications and results of side-to-side isoperistaltic strictureplasty in Crohn’s disease. Dis Colon Rectum, 2004; 47: 494–501
Uchino M, Ikeuchi H, et al. Long-term efficacy of strictureplasty for Crohn’s disease. Surgery Today, 2010; 40: 949–953
Acknowledgments
The authors would like to thank Ms. Elizabeth Crosby for her help.
Author information
Authors and Affiliations
Corresponding author
Additional information
This manuscript has not been presented or planned to be presented as a poster or on a podium.
Rights and permissions
About this article
Cite this article
Ambe, R., Campbell, L. & Cagir, B. A Comprehensive Review of Strictureplasty Techniques in Crohn’s Disease: Types, Indications, Comparisons, and Safety. J Gastrointest Surg 16, 209–217 (2012). https://doi.org/10.1007/s11605-011-1651-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-011-1651-2