Natural history of strictureplasty in Crohn's disease: 9-year experience.

OBJECTIVE

To study the short- and long-term outcomes in patients with Crohn's disease who have undergone strictureplasty.

DESIGN

A retrospective review with a prospective follow-up (mean 54.4 months [range from 4 to 108 months]).

SETTING

The Inflammatory Bowel Disease Centre at Mount Sinai Hospital in Toronto.

PATIENTS

Forty-three patients (29 men, 14 women) who underwent 154 strictureplasties for Crohn's disease. The mean age of the patients was 32.5 years (range from 17 to 55 years).

INTERVENTION

Strictureplasty by either the Heineke-Mikulicz (145 strictureplasties) or the Finney (9 strictureplasties) technique in the duodenum, small intestine and at the site of the previous anastomosis.

MAIN OUTCOME MEASURES

Factors studied for symptomatic recurrence included the type of procedure previously performed, the type of strictureplasty, the number of previous operations and the site of the disease.

RESULTS

There were no deaths. There was one documented leak. Twenty-six patients remained symptom free during the follow-up period. Fourteen patients required reoperation for progressive obstructive disease. None of the differences in the variables studied was statistically significant when related to the symptomatic recurrence rate. However, only 2 of 11 patients who had strictureplasty as the only procedure have required reoperation.

CONCLUSIONS

Strictureplasty is a safe and useful procedure in the management of extensive obstructive Crohn's disease. Strictureplasty does not seem to alter the natural history of the disease.