Strictureplasty vs resection in small bowel Crohn's disease: an evaluation of short-term outcomes and recurrence.
OBJECTIVE
To compare postoperative adverse events and recurrence following strictureplasty or bowel resection in patients with small bowel Crohn's disease (CD).


METHODS
A literature search was performed to identify studies published between 1980 and 2006 comparing outcomes of CD patients undergoing either strictureplasty or bowel resection. Hazard ratios were calculated from Kaplan-Meier plots of cumulative recurrence data. Quality assessment of the included studies was performed. Random-effect meta-analytical techniques were employed. Sensitivity analysis and assessment of heterogeneity were performed.


RESULTS
Seven studies comprising 688 CD patients (strictureplasty n = 311, 45%; resection with or without strictureplasty n = 377, 55%) were included. Patients undergoing strictureplasty alone had a lower risk of developing postoperative complications than those who underwent resection (OR = 0.60, 95% CI: 0.31-1.16) although this was not statistically significant (P = 0.13). Surgical recurrence after strictureplasty was more likely than after resection (OR = 1.36, 95% CI: 0.96-1.93, P = 0.09). Patients who had a resection had a significantly longer recurrence-free survival than those undergoing strictureplasty alone (HR = 1.08, 95% CI: 1.02-1.15, P = 0.01).


CONCLUSIONS
Patients with small bowel CD undergoing strictureplasty alone may have fewer postoperative complications than those undergoing a concomitant bowel resection. However, surgical recurrence maybe higher following strictureplasty alone than with a concomitant small bowel resection. Patients may require appropriate preoperative counselling regarding the pros and cons of each operative technique.
Reese
G E
GE
Department of Biosurgery and Surgical Technology, St Mary's Hospital, Imperial College London, London, UK.
Purkayastha
S
S
Tilney
H S
HS
von Roon
A
A
Yamamoto
T
T
Tekkis
P P
PP
D003424:Crohn Disease / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007421:Intestine, Small / Q000473:pathology*; D012008:Recurrence; D012680:Sensitivity and Specificity; D016896:Treatment Outcome