Long-term results of strictureplasty for ileocolonic anastomotic recurrence in Crohn's disease.

This study examined the outcome of strictureplasty for recurrence at the ileocolonic anastomosis after resection (ileocolonic strictureplasty) in Crohn's disease. The records of 42 patients who underwent ileocolonic strictureplasty between 1980 and 1997 were reviewed. The method of ileocolonic strictureplasty was Heineke-Mikulicz reconstruction for a short stricture (</=6 cm) in 41 patients and Finney reconstruction for a long stricture (20 cm) in one. Synchronous operations were performed for coexisting small bowel Crohn's disease in 17 patients: strictureplasty in eight, resection in two, and both in seven. Postoperatively there were two intra-abdominal abscesses, which were treated conservatively. There were no deaths. All except two patients had complete relief of symptoms after operation. Most of the patients who had preoperative weight loss gained weight (median gain +2.6 kg). After a median follow-up of 99 months, 24 patients (57%) had a symptomatic recurrence. Three patients were successfully managed by medical treatment. The other 21 patients (50%) required surgery for recurrence (20 for recurrence at the previous ileocolonic strictureplasty site). At present, two patients are symptomatic and currently receiving corticosteroid therapy. All other patients have had no recurrent symptoms. None of the patients have developed short bowel syndrome or small bowel carcinoma. Strictureplasty is a safe and efficacious procedure for ileocolonic anastomotic recurrence in Crohn's disease.