Better surgery for Crohn's

Newswise has an excerpt from an article in the Journal of Surgery which contains interesting research into the long-term success of surgery that avoids removing parts of the bowel.

Among other findings, the study supports the notion that strictureplasty -- a bowel-sparing surgical procedure commonly used to correct Crohn's-related strictures -- is less likely to lead to stricture recurrence later on, compared to surgical excision ("resection") of the stricture.

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In decades past, Crohn's patients typically underwent surgical removal of the bowel at the point of stricture, although in recent years, corrective, bowel-sparing "strictureplasties" have become much more common. Dr. Michelassi has been a pioneer in developing new strictureplasty techniques. But he says that, up till now, surgeons lacked good information on the long-term consequences of these operations compared with resection.

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The study also found that up to a third of recurrences occur away from the site of the original operation. Furthermore, the type and site of prior surgery appears to influence the pattern of recurrence, the researchers found. The study also provides new guidance on what surgeons call "prophylactic strictureplasty" -- procedures aimed at preventing stricture-related trouble.

"Sometimes we encounter a stricture that isn't giving the Crohn's patient any symptoms right now. We know, though, that these strictures can lead to trouble in about 25 percent of cases," Dr. Michelassi explains. "Based on our findings, we would now advise that if an asymptomatic stricture can be fixed using bowel-sparing strictureplasty, then the surgeon should go ahead and perform that type of prophylactic procedure," the NewYork-Presbyterian/Weill Cornell expert says. "However, if fixing the problem requires bowel resection, then we would advise leaving the stricture alone, because there's still a 75 percent chance it will not cause the patient any harm."