A team from the Cleveland Clinic Foundation, Ohio, USA, investigated the safety and long-term efficacy of strictureplasty in patients with obstructing small bowel Crohn's disease.
|Following strictureplasty, morbidity and surgical recurrence rates were 18% and 34%, respectively.
|Journal of the American College of Surgeons|
The researchers conducted a retrospective review of all patients undergoing strictureplasty for this condition, at the Cleveland Clinic between 1984 and 1999.
A total of 314 patients underwent a laparotomy that included the index strictureplasty. The total number of strictureplasties performed was 1,124, with a median of two per patient. 66% of patients underwent a synchronous bowel resection.
Recurrence was defined as the need for re-operation. Personal interviews, phone interviews, or both were used to determine follow-up information.
The team found the overall morbidity rate to be 18%, with septic complications occurring in 5% of patients. Preoperative weight loss and older age were found to be significant predictors of morbidity.
The surgical recurrence rate was 34%, with a median follow-up period of 7.5 years. Age was found to be a significant predictor of recurrence, with younger patients having a shorter time to re-operation.
Researcher David W. Dietz said on behalf of the group, "This large series of patients with long-term follow-up confirms the safety and efficacy of strictureplasty in patients with obstructing small bowel Crohn's disease.
"The 18% morbidity and 34% operative recurrence rates compare favorably with reported results of resective surgery. Caution should be used in patients with preoperative weight loss, because they experienced higher complication rates."
"Although young patients seem to follow an accelerated course, strictureplasty remains indicated as part of an overall strategy to conserve intestinal length," he concluded.