Safety and longterm efficacy of strictureplasty in 314 patients with obstructing small bowel Crohn's disease

BACKGROUND: Since its introduction in the early 1980s, strictureplasty (SXP ) has become a viable option in the surgical management of obstructing smal l bowel Crohn's disease. Questions still remain regarding its safety and lo ngterm durability in comparison to resection. Precise indications and contr aindications to the procedure are also not well defined. STUDY DESIGN: A retrospective review of all patients undergoing SXP for obs tructing small bowel Crohn's disease at the Cleveland Clinic between 1984 a nd 1999 was conducted. A total of 314 patients underwent a laparotomy that included the index SXP. The total number of SXPs performed was 1,124, with a median of two (range 1 to 19) per patient. Sixty-six percent of patients underwent a synchronous bowel resection. Recurrence was defined as the need for reoperation. Followup information was determined by personal interview s, phone interviews, or both. RESULTS: The overall morbidity rate was 18%, with septic complications occu rring in 5% of patients. Preoperative weight loss (p = 0.004) and older age (p = 0.008) were found to be significant predictors of morbidity. The surg ical recurrence rate was 34%, with a median followup period of 7.5 years (r ange 1 to 16 years). Age was found to be a significant predictor of recurre nce (p = 0.02), with younger patients having a shorter time to reoperation. CONCLUSIONS: This large series of patients with longterm followup confirms the safety and efficacy of strictureplasty in patients with obstructing sma ll bowel Crohn's disease. The 18% morbidity and 34% operative recurrence ra tes compare favorably with reported results of resective surgery. Caution s hould be used in patients with preoperative weight loss, because they exper ienced higher complication rates. Although young patients seem to follow an accelerated course, SXP remains indicated as part of an overall strategy t o conserve intestinal length. (J Am Coll Surg 2001;192:330-338. (C) 2001 by the American College of Surgeons).