RESULTS OF MULTIPLE STRICTUREPLASTIES IN DIFFUSE CROHNS-DISEASE OF THE SMALL-BOWEL

With extensive small bowel strictures due to Crohn's disease, resectio nal surgery may lead to short bowel syndrome. Strictureplasty (SP) has emerged as a useful alternative for selected strictures. This study r eviews the results of 42 patients with diffuse obstructive Crohn's dis ease of the small bowel in whom at least four SP were performed in eac h patient (median: 7; range: 4-15; total SP: 315). Twenty-three patien ts (55%) had had 1-5 previous small bowel resections. Co-existing perf orative disease was present in four patients (10%). Synchronous resect ion of a separate segment of small bowel was performed in 22 patients (52%). There was no operative mortality. Enterocutaneous fistula and/o r intra-abdominal abscess developed in three patients (7%) and only on e of these needed operative intervention. The median follow-up was 3 y ears (range: 10 months to 7 years). After SP, all patients experienced relief from obstructive symptoms. The median weight gain was 3 kg (ra nge: - 1 - 21 kg) and more than half the patients were weaned off ster oids. Symptomatic recurrence occurred in 10 patients (24%) and was due to strictures (N = 9) and/or perforative disease (N = 2) at new site( s) unrelated to previous SP. Rate of symptomatic restricture of the SP site was 1.6% and was associated with new strictures elsewhere in all cases. Thus, in selected cases, SP is a safe and effective treatment for diffuse Crohn's strictures.