title: Strictureplasty in diffuse Crohn's jejunoileitis: safe and durable.
abstract: OBJECTIVE
  As an alternative to resection, strictureplasty may allow for preservation of intestinal length and avoidance of short-bowel syndrome in patients with diffuse Crohn's jejunoileitis. However, the long-term durability of the procedure and its safety have not been confirmed. The purpose of this study was to report our experience with strictureplasty for diffuse Crohn's jejunoileitis.
  
  
  METHODS
  Between 1984 and 1999, 123 patients underwent a laparotomy that included an index strictureplasty for diffuse jejunoileitis. Patient history, operative details, and postoperative morbidities were obtained by chart review. Nineteen patients (15 percent) were receiving total parenteral nutrition for short-bowel syndrome, and 81 (66 percent) were taking chronic steroids. Total number of strictureplasties performed was 701 (median, 5/patient). Seventy percent of patients underwent a synchronous bowel resection. Follow-up information was determined by personal or phone interviews. Recurrence was defined as the need for reoperation, and risk was calculated by the Kaplan-Meier method. Patients with diffuse jejunoileitis were also compared with 219 patients with limited small-bowel Crohn's disease undergoing strictureplasty.
  
  
  RESULTS
  The overall morbidity rate was 20 percent, with septic complications occurring in 6 percent. The surgical recurrence rate was 29 percent with a median follow-up period of 6.7 (range, 1-16) years. The recurrence rate in diffuse jejunoileitis patients did not differ from that seen in patients with limited small-bowel Crohn's disease (P = 0.38). Short duration of disease and short interval since last surgery were significant predictors of accelerated recurrence (P = 0.008 and 0.04, respectively).
  
  
  CONCLUSIONS
  Strictureplasty is a safe and durable alternative to resection in diffuse Crohn's jejunoileitis. Patients with a short duration of disease and short interval since last surgery are at higher risk for accelerated recurrence. Patients with diffuse jejunoileitis do not appear to be at higher risk for recurrence than patients with more limited Crohn's disease.
authors.affiliation: Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: David W
authors.initials: DW
authors.lastname: Dietz
authors.forename: Victor W
authors.initials: VW
authors.lastname: Fazio
authors.forename: Sylvio
authors.initials: S
authors.lastname: Laureti
authors.forename: Scott A
authors.initials: SA
authors.lastname: Strong
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Hull
authors.forename: James
authors.initials: J
authors.lastname: Church
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
authors.forename: Ian C
authors.initials: IC
authors.lastname: Lavery
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Senagore
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003424:Crohn Disease / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007077:Ileal Diseases / Q000601:surgery*; D007579:Jejunal Diseases / Q000601:surgery*; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome