STRICTUREPLASTY WITHOUT CONCOMITANT RESECTION FOR SMALL-BOWEL OBSTRUCTION IN CROHNS-DISEASE

The efficacy of strictureplasty in the treatment of Crohn's disease is often attributed in part to concomitant resection of strictured small bowel segments. Fifty-four patients with obstructive Crohn's disease who underwent 215 strictureplasty procedures (Heineke-Mikulicz, 179; F inney, 36) without concomitant resection of small bowel were reviewed. The median age was 38 (range 18-66) years and the median follow-up 3 (range 1-7) years. The mean number of strictureplasties per patient wa s 4 (range 1-13). Twenty-four patients had undergone at least one prev ious small bowel resection. There was no operative death. Intraabdomin al abscess and enterocutaneous fistula occurred in two patients each a nd reoperation for sepsis was needed in one. At 1 year after surgery t he median weight gain was 4 kg; all but two patients had relief of obs tructive symptoms and 26 of 37 were weaned off steroids. Symptomatic r ecurrence occurred in 14 patients and seven required reoperation. Rate s of recurrent stricture and of new stricture or perforative disease w ere 2.3 per cent of strictureplasty sites and 26 per cent of patients respectively.