T Yamamoto1, M R Keighley. 1. University Dept. of Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
Abstract
BACKGROUND: There have been several reports on strictureplasty for Crohn's disease. However, in most of them the majority of the patients underwent synchronous bowel resections. The efficacy of strictureplasty has been often attributed to the synchronous bowel resection. This study was undertaken to assess the long-term results of strictureplasty alone for jejunoileal Crohn's disease. METHODS: Forty-three patients who underwent 135 primary strictureplasties without synchronous resection for jejunoileal Crohn's disease between 1980 and 1997 were reviewed. Factors affecting reoperation rates were examined by using a multivariate analysis. RESULTS: There were no operative deaths. Intra-abdominal septic complications (abscess/fistula) developed in 4 patients (9%). Abdominal symptoms were relieved in all but two patients, who required further surgery within 6 months after operation. After a median follow-up of 9 years 21 patients (49%) required reoperation for small-bowel recurrence. A multivariate analysis using Cox's proportional hazard model showed that only age at operation (<35 years, hazard ratio 11.1 versus >35 years, P = 0.002) was an independent significant factor affecting the reoperation rate. Sex, duration of symptoms, smoking, previous small-bowel resection, steroids use, preoperative nutritional status, and site, number, or length of strictureplasties did not affect the reoperation rates. At present all the patients are asymptomatic and receiving neither medical treatment nor nutritional support. CONCLUSIONS: Strictureplasty is a safe and efficacious procedure for jejunoileal Crohn's disease in the long term. Only youth was an independent significant risk factor for recurrence requiring surgery.
BACKGROUND: There have been several reports on strictureplasty for Crohn's disease. However, in most of them the majority of the patients underwent synchronous bowel resections. The efficacy of strictureplasty has been often attributed to the synchronous bowel resection. This study was undertaken to assess the long-term results of strictureplasty alone for jejunoileal Crohn's disease. METHODS: Forty-three patients who underwent 135 primary strictureplasties without synchronous resection for jejunoileal Crohn's disease between 1980 and 1997 were reviewed. Factors affecting reoperation rates were examined by using a multivariate analysis. RESULTS: There were no operative deaths. Intra-abdominal septic complications (abscess/fistula) developed in 4 patients (9%). Abdominal symptoms were relieved in all but two patients, who required further surgery within 6 months after operation. After a median follow-up of 9 years 21 patients (49%) required reoperation for small-bowel recurrence. A multivariate analysis using Cox's proportional hazard model showed that only age at operation (<35 years, hazard ratio 11.1 versus >35 years, P = 0.002) was an independent significant factor affecting the reoperation rate. Sex, duration of symptoms, smoking, previous small-bowel resection, steroids use, preoperative nutritional status, and site, number, or length of strictureplasties did not affect the reoperation rates. At present all the patients are asymptomatic and receiving neither medical treatment nor nutritional support. CONCLUSIONS: Strictureplasty is a safe and efficacious procedure for jejunoileal Crohn's disease in the long term. Only youth was an independent significant risk factor for recurrence requiring surgery.