[Intestinal surgery in the treatment of stenoses of the small intestine in Crohn disease].
Strictureplasty is an alternative to extensive and/or multiple small bowel resections in the surgical treatment of Crohn's disease. We here report a series of 22 patients (12 M-10 F--mean age years: 28). All patients had a non-perforative form of Crohn's disease lasting for a mean of 8 years. Nine out of 22 had had previous intestinal resection. A total of 201 stenosis was identified during peroperative examination (mean per patient: 9). Only tight stenoses (diameter < 2 cms) were treated while others were left untouched (n = 22 in 11 patients). Eighty-three stenoses were treated by short strictureplasty and 24 by long strictureplasty using steel thread. One or several resections were simultaneously performed in 15 patients. Mortality was nil. A post operative abscess without loosened suture was drained. The mean follow-up in the 22 patients was 24 months (3-7 years). Clinical and radiological symptoms of stenosis were relieved after strictureplasty. Clinical recurrence occurred in 5 patients among 12 followed-up more than 2 years. Subsequent surgery was required in 4: in one case hemorrhagic ulceration developed within a long strictureplasty and in 3 others stenosis developed in plasty areas but also in previously healthy areas. In conclusion, strictureplasty is a short and long-term efficient procedure in the treatment of Crohn's disease stenosis. It allows limiting extensive intestinal resection. A more prolonged follow-up is needed in order to evaluate the rate of long-term recurrence and complications that would limit the interest of this technique.
Quandalle
P
P
Clinique Chirurgicale Ouest, CHRU, Lille.
Gambiez
L
L
Colombel
J F
JF
Paris
J C
JC
Cortot
A
A
D000293:Adolescent; D000328:Adult; D003424:Crohn Disease / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007077:Ileal Diseases / Q000209:etiology / Q000601:surgery*; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D007579:Jejunal Diseases / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D012086:Reoperation
Les plasties intestinales dans le traitement des sténoses de l'intestin grêle au cours de la maladie de Crohn.