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AimTo evaluate the frequency and outcome of strictureplasty in the era of biologicals and to compare patients operated on by strictureplasty alone, resection alone or a combination of both.MethodA retrospective review of all patients undergoing strictureplasty for obstructing jejunoileal Crohn's disease (CD) in Oxford between 2004 and 2016 was conducted. For comparison, a cohort of CD patients with resection only during 2009 and 2010 was included.ResultsIn all, 225 strictureplasties were performed during 85 operations, 37 of them in isolation and 48 with simultaneous resection. Another 82 procedures involved resection only; these patients had shorter disease duration, fewer previous operations and longer bowel preoperatively. The frequency of strictureplasty procedures did not alter during the study period and was similar to that in the preceding 25 years. There was no postoperative mortality. One patient required re-laparotomy for a leak after strictureplasty. None developed cancer. The 5-year reoperation rate for recurrent obstruction was 22% (95% CI 12-39) for resection alone, 30% (17-52) for strictureplasty alone and 42% (27-61) for strictureplasty and resection (log rank P = 0.038). Young age was a risk factor for surgical recurrence (log rank P = 0.006).ConclusionThe use of strictureplasty in CD has not changed significantly since the widespread introduction of biologicals. Surgical morbidity remains low. The risk of recurrent strictures is high and young age is a risk factor. In this study, strictureplasty alone was associated with a lower rate of reoperation compared with strictureplasty with resection.

Original publication

DOI

10.1111/codi.15013

Type

Journal article

Journal

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

Publication Date

09/2020

Volume

22

Pages

1159 - 1168

Addresses

Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.

Keywords

Intestine, Small, Humans, Crohn Disease, Intestinal Obstruction, Recurrence, Treatment Outcome, Reoperation, Retrospective Studies