Strictureplasty vs resection in small bowel Crohn's disease: an evaluation of short-term outcomes and recurrence

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Colorectal Disease

Volume 9 Issue 8 Page 686-694, October 2007

To cite this article: G. E. Reese, S. Purkayastha, H. S. Tilney, A. von Roon, T. Yamamoto, P. P. Tekkis (2007) Strictureplasty vs resection in small bowel Crohn's disease: an evaluation of short-term outcomes and recurrence Colorectal Disease 9 (8), 686–694. doi:10.1111/j.1463-1318.2006.01114.x

Meta-Analysis

Strictureplasty vs resection in small bowel Crohn's disease: an evaluation of short-term outcomes and recurrence

*Department of Biosurgery and Surgical Technology, St 's Hospital, Imperial College London, London, UK and †Inflammatory Bowel Disease Center, Yokkaichi Social Insurance Hospital, Yokkaichi, Mie, Japan

P. P. Tekkis MD FRCS, Senior Lecturer/Consultant Colorectal Surgeon, Imperial College London, Department of Biosurgery and Surgical Technology, St 's Hospital, 10th Floor QEQM Building, Praed Street, London W2 1NY, UK.E-mail: p.tekkis@...

Abstract

Aim To compare postoperative adverse events and recurrence following strictureplasty or bowel resection in patients with small bowel Crohn's disease (CD).

Method 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).

Conclusion 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.