Strictureplasty for Crohn's disease - Meta-analysis

PURPOSE: The objective of this study was to analyze patient outcome after s trictureplasty for management of intestinal stricture caused by Crohn's dis ease based on differences in surgical procedures. METHODS: A MEDLINE search was performed using a medical subject heading analysis for strictureplasty in Crohn's disease. Meta-analysis of multiple variables for outcome was pe rformed using random-effects models. RESULTS: Five hundred six patients und erwent 1,825 strictureplasties for Crohn's disease with minimal morbidity a nd zero mortality. Ninety percent of strictures were less than 10 cm in len gth. Approximately 85 percent of these procedures used the Heineke-Mihulicz technique and 13 percent used Finney strictureplasty. Forty-four per cent of procedures included concurrent bowel resection. Recurrence rate of Crohn 's disease after strictureplasty was increased in patients with longer stud y duration after surgery (P = 0.04), who showed symptoms of active disease (P = 0.02), who experienced preoperative weight loss (P = 0.02), or who rec eived the Heineke-Mikulicz procedure (P = 0.008). The proportion of patient s requiring additional surgery was increased with longer study duration (P 0.006), with preoperative weight loss (P = 0.001), or with the Heineke-Miku licz procedure (P = 0.005). The proportion of patients requiring additional surgery was decreased when a Finney strictureplasty was used (P = 0.008) a s compared with those treated by the Heineke-Mikulicz procedure. CONCLUSION : Although the Heineke-Mihulicz technique is most often used for Crohn's st rictureplasty, outcome analysis revealed the Finney strictureplasty may red uce the reoperation rate.