Strictureplasty is an effective option in the operative management of duodenal Crohn's disease

INTRODUCTION: Duodenal Crohn's disease requiring surgery has traditionally been managed with a bypass procedure. We compared our experience with duode nal strictureplasty with this traditional approach. METHODS: Records of pat ients operated on for duodenal Crohn's disease since 1980 were retrospectiv ely reviewed. Patients having strictureplasty or bypass were compared with regard to demographics, indications, complications, and outcome. RESULTS: S ince 1980, 34 patients were operated on for duodenal Crohn's disease. Mean age was 38.9 (range, 16-68) years, and 20 of 34 patients were females, with no significant differences between operative groups. Obstruction was the p resenting symptom in 33 of 34 patients, and all had strictures. The basis f or diagnosis of duodenal Crohn's disease was macroscopic appearance and the presence of Crohn's elsewhere in 29 of 34 patients, with only 5 of 34 havi ng either duodenal or contiguous antral granulomas. Thirty-seven strictures were present in the 34 patients; 24 were in the proximal duodenum (8 stric tureplasty, 16 bypass), 9 were in the midduodenum (4 strictureplasty, 5 byp ass), and 4 were in the distal duodenum (3 strictureplasty, 1 bypass). Bypa ss was performed in 21 patients, with two operative complications, and at a mean follow-up of 8 years, 1 of 21 patients required reoperation for recur rent disease. Strictureplasty was performed in 13 patients, with two operat ive complication,and at a mean follow-up of 3.6 years, 1 patient required r eoperation for recurrence also. Vagotomy was performed in 16 of 21 bypasses and 7 of 13 strictureplasties. CONCLUSIONS: Although follow-up is shorter, strictureplasty is a safe and effective operation for duodenal Crohn's dis ease and should be considered when feasible.