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Short- and long-term outcomes of strictureplasty for obstructive Crohns disease
Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Oxford Univ Hosp NHS Fdn Trust, England; Ryhov Cty Hosp, Sweden.ORCID iD: 0000-0001-6808-371X
Oxford Univ Hosp NHS Fdn Trust, England.
Oxford Univ Hosp NHS Fdn Trust, England.
Univ Oxford, England.
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2020 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 22, no 9, p. 1159-1168Article in journal (Refereed) Published
Abstract [en]

Aim To evaluate the frequency and outcome of strictureplasty in the era of biologicals and to compare patients operated on by strictureplasty alone, resection alone or a combination of both. Method A retrospective review of all patients undergoing strictureplasty for obstructing jejunoileal Crohns disease (CD) in Oxford between 2004 and 2016 was conducted. For comparison, a cohort of CD patients with resection only during 2009 and 2010 was included. Results In all, 225 strictureplasties were performed during 85 operations, 37 of them in isolation and 48 with simultaneous resection. Another 82 procedures involved resection only; these patients had shorter disease duration, fewer previous operations and longer bowel preoperatively. The frequency of strictureplasty procedures did not alter during the study period and was similar to that in the preceding 25 years. There was no postoperative mortality. One patient required re-laparotomy for a leak after strictureplasty. None developed cancer. The 5-year reoperation rate for recurrent obstruction was 22% (95% CI 12-39) for resection alone, 30% (17-52) for strictureplasty alone and 42% (27-61) for strictureplasty and resection (log rankP = 0.038). Young age was a risk factor for surgical recurrence (log rankP = 0.006). Conclusion The use of strictureplasty in CD has not changed significantly since the widespread introduction of biologicals. Surgical morbidity remains low. The risk of recurrent strictures is high and young age is a risk factor. In this study, strictureplasty alone was associated with a lower rate of reoperation compared with strictureplasty with resection.

Place, publisher, year, edition, pages
WILEY , 2020. Vol. 22, no 9, p. 1159-1168
Keywords [en]
Crohns disease; stricturing disease; stricture; strictureplasty; morbidity; recurrence
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-169345DOI: 10.1111/codi.15013ISI: 000562300400001PubMedID: 32053253OAI: oai:DiVA.org:liu-169345DiVA, id: diva2:1466658
Note

Funding Agencies|Bengt Ihre Research Fellowship; National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC)National Institute for Health Research (NIHR)

Available from: 2020-09-12 Created: 2020-09-12 Last updated: 2021-12-29

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