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Stricturing Crohn’s Disease: Strictureplasty

  • Gabriele Bislenghi
  • Andre D’HooreEmail author
Chapter

Abstract

The occurrence of strictures as a complication of Crohn’s disease is a significant clinical problem which may be present at initial diagnosis or develop many years later. Clinical presentation depends on stricture location and severity of stenosis. Strictures frequently contain a mixture of inflammatory and fibrotic tissue. To date, no antifibrotic agent exists and the effect of anti-inflammatory and immunomodulatory drugs on the fibrotic component of Crohn’s strictures remains extremely limited. In this scenario, surgery is frequently unavoidable. Resection of the affected bowel segment has represented for decades the only surgical option. In order to preserve bowel length, non resective techniques such as strictureplasties have gained progressively a role in the treatment of Crohn’s strictures and have been proven to be comparable to resections with regard to early and long-term postoperative results and recurrence rate. To better appreciate similarities and differences among the several techniques proposed, strictureplasties can be classified into three main groups including Heineke-Mikulicz like procedures, intermediate procedures (Finney and Jaboulay) and entero-enterostomies (Michelassi like procedures). As ultimate bowel sparing technique, a modified side-to-side isoperistaltic strictureplasty over the ileocecal valve has been recently proposed with encouraging results. Furthermore, mucosal healing has been frequently observed at endoscopic evaluation after surgery. It might be speculated that the alleviation of faecal stasis disrupts the inflammatory process, restores the physiological microbial-mucosa interaction and promote the anatomical and functional recovery of the treated bowel segment. In view of this, the notion of the irreversibility of intestinal fibrosis has to be challenged. Further research should better clarify the mechanism of mucosal healing and delineate therapeutic approaches to trigger the reversal of fibrosis in Crohn’s disease.

Keywords

Crohn’s disease Fibrosis Stricture Surgery Strictureplasty 

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Authors and Affiliations

  1. 1.Department of Abdominal SurgeryUniversity Hospital LeuvenLeuvenBelgium

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