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%-90% 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 in the treatment of complications from CD.1,3,4 In strictureplasty, no part of the bowel is removed but the narrowed section of small bowel is widened without removing it. This can be beneficial for some patients 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 bloodstreams. For this reasons, a colorectal surgeon may recommend strictureplasty in order 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 bowel so that after recovery, digested food will be able to pass through without blockage. This procedure can be done on multiples strictures during a single surgery, if necessary.3,4

What happens after strictureplasty for CD?

Patients 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 potential complications associated with strictureplasty?

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

  • Infection at surgical site
  • Adverse reaction to anesthesia
  • Bleeding in bowel
  • Fluid leaking from stitches in 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.

Written by: Anna Nicholson and Emily Downward | Last Reviewed: January 2018.
View References
  1. Cima RR, Wolff BG. Reoperative Crohn's Surgery: Tricks of the Trade. Clinics in Colon and Rectal Surgery. 2007;20(4):336-343. doi:10.1055/s-2007-991034.
  2. Surgery for Crohn's Disease and Ulcerative Colitis. Crohn's and Colitis Foundation of America. Available at: http://www.crohnscolitisfoundation.org/resources/surgery-for-crohns-uc.html. Accessed 1/23/18.
  3. Aman MW. "Strictureplasty." Available at http://emedicine.medscape.com/article/1893397-overview. Accessed 1/24/18.
  4. Jobanputra S, Weiss EG. Strictureplasty. Clin Colon Rectal Surg 2007 Nov; 20(4): 294-302.
  5. Short bowel syndrome. The National Institute of Diabetes and Digestive and Kidney Diseases. Available at: http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/short-bowel-syndrome/Pages/facts.aspx. Accessed 1/24/18.
  6. Strictureplasty complications. Stanford Health Care. Available at https://stanfordhealthcare.org/medical-treatments/s/strictureplasty/complications.html. Accessed 1/24/18.