Strictureplasty

Crohn’s disease (CD) and ulcerative colitis (UC) are the two major forms of inflammatory bowel disease (IBD). Both cause chronic inflammation in the digestive tract. While the inflammation in UC is confined to the colon and rectum, inflammation in CD can occur anywhere along the digestive tract, from the mouth to the anus.¹

One of the common complications that many people with CD experience is strictures. The patchy nature of the inflammation in CD may cause different symptoms along the digestive tract at different times. People with CD usually have sections of their intestines affected by active disease that are located in between sections of healthy intestine. Strictures occur when the diseased sections of the intestines become too narrow, which can block digested food from passing through the small intestine. This can cause painful cramping when the areas of healthy bowel try to push digested food through the section with the stricture.^1,2

Between 70 and 90 percent of people with CD will require surgery for their disease at some point. In some cases, the surgical treatment will be needed for strictures. The surgical procedure to treat strictures is called strictureplasty. Strictureplasty may be combined with small bowel resection.³

What is strictureplasty?

Strictureplasty is one of the surgical procedures used to treat complications from CD.^1,3,4 In strictureplasty, no part of the bowel is removed, but the narrowed section of the small bowel is widened without removing it. This can be helpful for some people who have had a recurrence of disease after a bowel resection surgery, in which diseased portions of the small bowel are removed entirely.

The small intestine plays an important role in absorbing nutrients from the food we eat into our bloodstream. For this reason, a colorectal surgeon may recommend strictureplasty to leave as much of the small bowel in place as possible. This may avoid a possible complication of small bowel resection surgery, called “short bowel syndrome,” which can cause a person to become undernourished.^3-5

What happens during strictureplasty for CD?

During strictureplasty surgery, the colorectal surgeon will guide a small, inflated balloon through the intestine. If the balloon hits a point of resistance, this may be a sign of a stricture in the intestine.

If a stricture is found, the surgeon will make a small cut along its length and then sew up the cut in the opposite direction. This shortens and widens the strictured section of the bowel so that after recovery, digested food will be able to pass through without blockage. This procedure can be done on multiple strictures during a single surgery, if needed.^3,4

What happens after strictureplasty for CD?

People who undergo strictureplasty surgery will typically spend several days recovering in the hospital. Additional medication may be prescribed during the recovery period. A healthcare provider who specializes in strictureplasty will advise patients about the best way to take care of themselves during their recovery period.

What are the possible side effects?

As with any surgery, there are potential risks and complications linked to strictureplasty. These include:⁶

• Infection at the surgical site
• Adverse reaction to anesthesia
• Bleeding in bowel
• Fluid leaking from stitches in the bowel
• Reformation of strictures over time

Overall, strictureplasty is considered a safe and effective option for treating small bowel strictures caused by CD. However, as with other types of surgery for CD, many patients who have strictureplasty will eventually experience a recurrence of the disease that requires another surgery.