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

[Guest guest]



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

Authors: Reese, G. E.1; Purkayastha, S.1; Tilney, H. S.1; von Roon, A.1; Yamamoto, T.2; Tekkis, P. P.1

Source: Colorectal Disease, Volume 9, Number 8, October 2007 , pp. 686-694(9)

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.

Keywords: Crohn's disease; strictureplasty; resection; meta-analysis

Document Type: Research article

DOI: 10.1111/j.1463-1318.2006.01114.x

Affiliations: 1: Department of Biosurgery and Surgical Technology, St 's Hospital, Imperial College London, London, UK 2: Inflammatory Bowel Disease Center, Yokkaichi Social Insurance Hospital, Yokkaichi, Mie, Japan