Strictureplasty Surgery for Crohn's Disease

Surgery is commonly used to treat Crohn’s disease. In fact, more than 80% of all people who have Crohn’s disease in the small intestine will have surgery in the first 10 years after diagnosis. While the most common type of surgery is a resection, which is used to remove diseased sections of the bowel, a second common procedure is a strictureplasty.

A strictureplasty is a type of surgery that is used to open up a narrowed section of intestine. Unlike a resection surgery, parts of the bowel aren't removed during a strictureplasty, making it an appealing alternative to a resection when possible. Strictureplasty may be done alone, or it may be done at the same time as a resection.

Strictureplasty is not typically done for the other main form of inflammatory bowel disease (IBD), ulcerative colitis. This is because ulcerative colitis is much less likely than Crohn's disease to cause strictures.

What Is a Stricture?

A stricture is when part of the bowel becomes narrowed. In Crohn's disease, a stricture is caused when the walls of the bowel become inflamed and scarred. The scar tissue encroaches on the inside space of the bowel, which is called the lumen. Without enough space for waste material to pass through, stool can build up inside the intestine at the stricture site, causing a partial or a total blockage. This can significantly reduce quality of life because diet often needs to be restricted, and there may be symptoms such as pain and diarrhea.

There are different degrees of strictures, and some might not cause any problems at all. However, when a stricture gets to be troublesome, it might need to be opened through surgery.

How Strictureplasty Works

There are several different ways that a surgeon can approach a stricture. Which technique is chosen will depend on the size of the stricture and the preference of the colorectal surgeon. Different strictureplasty techniques have been developed in order to save as much of the intestine as possible. Removing too much small intestine can result in problems absorbing nutrients from food, so it's important to avoid removing sections when possible.

Risks

The risks might be different depending on the technique used for the surgery. One study found that there were 15 different types of strictureplasty surgery in the published literature. Another study, a meta-analysis, looked at a total of 3,259 strictureplasty surgeries to come up with some ballpark estimates of the risks. For patients that had strictureplasty surgery in the ileum or the jejunum (the middle and last parts of the small intestine), 4% experienced a complication such as a leak, fistula, or abscess. After five years, there were 28% of patients who had a recurrence of the stricture. The authors concluded that strictureplasty in the ileum or jejunum was a safe and effective procedure. There were too few surgeries done on the first part of the small intestine (the duodenum) and in the colon to make any judgements about the effectiveness, or whether more treatment might be needed in the future.

What to Know Before Surgery

Some of the things to ask a surgeon before strictureplasty include:

• How big is the stricture?
• Will any of your intestine need to be removed?
• How is the surgery going to be done? (As in, a basic explanation of the technique.)
• What are the risks?
• Is there any plan in place in case of an unexpected problem?
• How long will you be in the hospital?
• How long will your recovery be?
• When can you return to normal activities (such as work or school)?

A Word From Verywell

Strictureplasty, overall, is a safe and effective type of surgery for Crohn's disease. It has the benefit of saving parts of the small intestine, unlike a resection. There are risks, as there are with any surgery, but studies have shown them to be small.