THE RESULTS OF STRICTUREPLASTY IN PEDIATRIC-PATIENTS WITH MULTIFOCAL CROHNS-DISEASE

This study is a retrospective review of eight pediatric patients with multifocal intestinal Crohn's disease who underwent strictureplasty wi th or without concomitant bowel resection between January 1978 and Apr il 1992. The patients ranged in age from 9.9 years to 18.5 years. Indi cations for surgery were partial intestinal obstruction (n = 6), failu re of medial therapy or steroid dependence (n = 4), growth failure (n = 2), and enterocutaneous fistula (n = 2). Thirty-six strictureplastie s were performed in the eight patients (median, 4.5 strictureplasties per patient; range, 1-12). Bowel resection was performed in six of the eight patients in areas where strictureplasty was not feasible. The m ean length of resection was 40 cm (range, 15-82 cm). The only complica tion was intestinal hemorrhage, which was conservatively managed in tw o patients. The patients were followed for a mean of 19 months (range, 3-55 months). Five patients had a weight below the fifth percentile p rior to surgery. Postoperatively, there was a weight gain in seven pat ients, including all five patients who were originally below the fifth percentile. A statistically significant weight gain was found when a paired t test analysis was applied to the entire group (p = 0.04). Fiv e of six patients who were on steroid medication at the time of surger y were successfully weaned within 1.5-3 months (mean, 2.3 months) from the time of surgery. Seven of eight patients had relief of their inte stinal symptoms. Strictureplasty with small-bowel resection, or perhap s strictureplasty alone, in pediatric patients with multifocal intesti nal Crohn's disease can improve gastrointestinal symptoms, promote wei ght gain, and allow discontinuation of steroid medications. Stricturep lasty should be considered for patients who are refractory to medical therapy or dependent on chronic steroid medication for control of thei r symptoms.