Strictureplasty in Complex Crohn's Disease: Beyond the Basics

Abstract

The strictureplasty operation was originally adopted for use in selected patients with Crohn's disease to allow for bowel conservation. The procedure and its usage have evolved over time as experience and confidence with the technique has grown. The short- and long-term outcomes of strictureplasty compared with resection attest to its safety and durable efficacy.

Keywords: Crohn's disease; bowel conservation; short bowel; small bowel; strictureplasty.

Fig. 1

The Heineke-Mikulicz strictureplasty is constructed by creating a longitudinal enterotomy (A) that is transversely closed in one or two layers using interrupted sutures (B). The site is marked by applying a clip to the mesenteric margin (C). Copyright retained by CCF.

Fig. 2A-C

The Finney strictureplasty is constructed by creating a longitudinal enterotomy and folding the bowel on itself (A). The back wall of the enterotomy is closed in two layers using running sutures reinforced with interrupted sutures (B). The front wall is closed in the same manner or with interrupted sutures placed in one or two layers (C). With permission and use by Cleveland Clinic Foundation. Copyright retained by CCF.

Fig. 3

The Michelassi strictureplasty is constructed by creating a longitudinal enterotomy and dividing the strictured segment in its midpoint before sliding the two segments into an isoperistaltic configuration (A). The back wall of the enterotomy is closed in two layers using running sutures reinforced with interrupted sutures (B). The front wall is closed in the same manner or with interrupted sutures placed in one or two layers (C). Copyright retained by CCF.