Strictureplasty surgery for Crohn’s disease

Strictureplasty surgery opens up narrowings of the bowel (strictures) which can be caused by damage from Crohn’s disease, a form of inflammatory bowel disease (IBD). Strictureplasty is also known as stricturoplasty.

What forms of IBD is strictureplasty surgery used to treat?

Crohn’s disease affecting the small intestine - ileocolitis, Ileitis, jejunoileitis, and gastroduodenal Crohn's disease (though it is less effective for this type of Crohn’s).

Why is strictureplasty surgery needed for Crohn's disease?

When scar tissue, caused by damage from active Crohn’s disease and healing, builds in the small intestine wall it can cause strictures (a narrowing) of the bowel or blockages. Surgery is needed open up these narrowings to allow the free flow of digested food.

Strictureplasty surgery is often used to reduce the risk of developing short-bowel syndrome which can happen when large sections of the small intestine are removed.

How is strictureplasty surgery done?

A strictureplasty is a way of treating the stricture or blockage without removing any sections of the gut.

This procedure can be carried out in several places along the small intestine at the same time. It leaves in place the damaged part of the gut (which may be diseased).

Before the surgery the extent and location of the strictures are investigated. This is generally done using a CT or MRI scan, but in some cases an endoscopy may be carried out.

For the procedure you will generally be placed under general anaesthetic in hospital. The surgeon will then make an incision (cut) over the section of damaged intestine and locate the exact point of the stricture(s). The damaged sections are then cut open and reshaped. How this is done will depend on the size of the stricture but generally the damaged section of the intestine is cut crossways and then reshaped by sewing it up in the opposite direction.

Once all strictures have been repaired the incision in your abdomen is closed using stitches.

Recovering from strictureplasty surgery

People who have strictureplasty surgery generally stay in hospital for around 9-10 days to recover.

The time it takes can vary on your pre and post-surgery health. You may be given some specific guidelines to follow after your surgery once you have returned home to help aid recovery - such as a special diet, avoiding heavy lifting and not driving.

Possible complications of strictureplasty surgery

• Abdominal bleeding
• Bowel obstruction
• Fistulas
• Abscesses
• Recurrence of strictures
• There are other risks associated with any surgery and general anesthetic which you should discuss with your surgeon

Things to know about strictureplasty surgery

• Cannot be used for long sections of strictures or blockages
• Many Crohn’s disease patients will require surgery at some point during their lifetime (up to 70%) which could involve removing parts of the bowels. Strictureplasty surgery was developed so that it is not always necessary to remove parts of the bowel - which can lead to the very serious small bowel syndrome. People with small bowel syndrome can become malnourshied as there is less bowel to absorb vitamins and minerals from food
• This is not a cure - there is no cure for IBD
• Studies have shown this is a safe and effective procedure
• It keeps your small intestines working in the most natural way
• As no bowel is removed any diseased tissue is left in situ
• It is a fairly new surgical technique and there is only around 10 years of follow-up information for people who’ve received it. This means the long-term outcome of strictureplasty is not yet known
• Some studies show a very slight increased risk in the need for additional surgeries after several years in people who have had strictureplasty surgery compared with those who have had resections. Recurrence rates are around 15% in 2 years and 20% at 5 years