[Repair of stricture in Crohn's disease: treatment of choice?].
Strictureplasty has become one of the surgical options available for skip-lesions and for duodenal, multiple small bowel or anastomotic strictures caused by Crohn's disease. Over a sixteen-year period, 44 patients underwent strictureplasty for 269 symptomatic strictures associated with Crohn's disease. After a median follow-up of 50 months (range 18-89) a second additional operation for symptomatic recurrence was performed in 10 patients, two of whom developed new symptomatic strictures after 3 and 36 months, requiring a third operation. Of all the strictures present at surgery, 174 were treated performing strictureplasties (156 were closed transversely using Heineke-Mickulicz, 16 in a side-to-side Finney fashion and 2 in the manner of Jabolay) and 88 with synchronous resection. Furthermore, 7 other strictures were treated with a side-to-side ileocolic (5 strictures in 3 patients) or ileoileal (2 strictures in one patient) anastomosis. No operative mortality was recorded and there were no septic complications due to anastomotic leak. The mean follow-up period was 47.8 +/- 42.4 months (range 3-132). Symptomatic restrictures of previous strictureplasty sites requiring surgery occurred in 8.8% of cases. Furthermore, no statistically significant difference (Kaplan-Meier) was observed in the reoperation rate among patients affected respectively by skip lesions or multiple strictures or among patients treated only by strictureplasty or with an associated resection. We concluded that strictureplasty is a valuable adjunct to resection in the treatment of Crohn's strictures.
Tonelli
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F
Dipartimento di Fisiopatologia Clinica, Università degli Studi di Firenze.
Ficari
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F
Bagnoli
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S
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D003106:Colon / Q000473:pathology / Q000601:surgery*; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D003424:Crohn Disease / Q000150:complications* / Q000601:surgery*; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
La stricturoplastica nella malattia di Crohn: intervento di scelta?