title: Comparison of conventional and nonconventional strictureplasties in Crohn's disease:  a systematic review and meta-analysis.
abstract: BACKGROUND
  The Heineke-Mikulicz and Finney techniques are conventional strictureplasties that have been used to manage short (<10 cm) and medium-length (>10 cm and <20 cm) strictures from Crohn's disease. Nonconventional strictureplasty techniques have emerged to facilitate bowel conservation for atypical strictures. These techniques include the modified Finney, combined Heineke-Mikulicz and Finney, modified Heineke-Mikuliczs, Michelassi, and modifications of it and others.
  
  
  OBJECTIVE
  The aim of this study is to compare conventional vs nonconventional strictureplasties with respect to short-term complications and long-term results.
  
  
  METHODS
  A MEDLINE search was performed using "Crohn's disease", "surgical therapy", "strictureplasty", "complications", "reoperation", and "recurrence" as medical subject headings. Studies conducted between 1975 and June 31, 2010 were found via PubMed, Ovid, Embase, and Cochrane databases and categorized into 3 groups. These groups consist of centers performing conventional strictureplasties, nonconventional strictureplasties, or both. Studies with at least 3 patients were reviewed.
  
  
  METHODS
  A mixed-effects meta-analysis for each outcome was performed by use of Supermix software by SSI Scientific Software International.
  
  
  METHODS
  We focused on immediate and long-term complication rates among the groups. The 6 immediate complications include small-bowel obstructions, sepsis, other infections, reoperations, early postoperative GI bleeds, and other early complications. The 5 long-term complications include recurrent strictures, small-bowel obstructions, reoperations, carcinoma, and deaths.
  
  
  RESULTS
  We reviewed 32 studies with 1616 patients who underwent 4538 strictureplasties. One thousand one hundred fifty-seven patients underwent conventional strictureplasties with an early complication rate of 15%; 459 patients underwent nonconventional strictureplasties with an early complication rate of 8%. A late complication rate of 29% for the conventional strictureplasty group and 17% for the nonconventional strictureplasty group was noted.
  
  
  CONCLUSIONS
  We are limited by the data published with the inherent risk of finding and analyzing mostly articles with positive results.
  
  
  CONCLUSIONS
  The nonconventional strictureplasty techniques were noninferior to the conventional strictureplasty procedures with respect to all prespecified outcomes.
authors.affiliation: Loyola University Stritch School of Medicine, Maywood, Illinois, USA.
authors.forename: Lorna
authors.initials: L
authors.lastname: Campbell
authors.forename: Ronald
authors.initials: R
authors.lastname: Ambe
authors.forename: James
authors.initials: J
authors.lastname: Weaver
authors.forename: Sue M
authors.initials: SM
authors.lastname: Marcus
authors.forename: Burt
authors.initials: B
authors.lastname: Cagir
mesh_terms: D003251:Constriction, Pathologic; D003424:Crohn Disease / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery; D011183:Postoperative Complications; D012008:Recurrence; D012086:Reoperation