Use Of Strictureplasty In Crohn's Disease

Question 0

What are indications for strictureplasty?

Answer 0

Diffuse involvement of small bowel with stricture, prior small bowel resection greater than 100cm, rapid recurrence of Crohn’s disease with obstruction, and an obstructing, fibrotic small bowel stricture without associated sepsis

Question 1

Where can strictureplasty performed?

Answer 1

On all small bowel and ileocecal strictures.

Question 2

What are the contraindications to strictureplasty?

Answer 2

Albumin less than 2; free or contained perforation of bowel associated with stricture; phlegmonous inflammation, internal fistula, external fistula involving affected site; stricture close in the proximity to a resection site; multiple strictures within a short segment in a patient who has not had prior small bowel respect ions or in a patient with sufficient small bowel length; any stricture with pathologic evidence of dysphasia or malignancy

Question 3

Do strictures need biopsy?

Answer 3

Any colonic stricture must undergo biopsies to rule out malignancy, as there is a high risk of occult malignancy

Question 4

What are the types of strictureplasty?

Answer 4

Heineke-Mikulicz, Finney and side to side isoperistalic

Question 5

What sizes are appropriate for each type of strictureplasty?

Answer 5

Short segments (20cm) for side to side isoperistalic

Question 6

What is the most complication from strictureplasty?

Answer 6

Bleeding from the strictureplasty site

Question 7

What are the risk factors for complications s/p strictureplasty?

Answer 7

Hypoalbuminemia, preoperative weight loss, emergency operations, presence of an intraabdominal abscess with peritoneal contamination, anemia, and older age

Question 8

What are the risk factors for recurrence s/p strictureplasty?

Answer 8

Younger age, short duration of disease, and short interval since previous resection