Abstract: Objective:To explore the clinical effect of surgical treatment of stricturing Crohn′s disease (CD).
Methods:The retrospective crosssectional study was conducted. The clinical data of 28 patients with stricturing CD who were admitted to the First Affiliated Hospital of Zhejiang University School of Medicine between June 2013 and April 2016 were collected. After improving the patients′ nutritional status by preoperative corresponding treatment and optimizing the risk factors of complications, patients received individualized therapy according to their conditions. The intestinal onestage resection and anastomosis or ostomy were performed at the stenotic locus causing sypmtoms, and no treatment or angioplasty for stenosis was performed at the gentle stenotic locus. Patients received regularly postoperative outpatient reexaminations. The medication was used to prevent recurrence according to the individual conditions. Observation indicators: surgical procedures (open or laparoscopic surgery), operation time, volume of intraoperative blood loss, number of patients with intraoperative blood transfusion, length of intestine resected, anastomosis methods, angioplasty for stenosis, duration of postoperative hospital stay, postoperative complications and followup. Followup using outpatient examination, telephone interview and wechat was performed to detect the abdominal pain, diarrhea, symptoms of clinical recurrence and endoscopic recurrence situations up to July 2016.
Results:All the 28 patients with stricturing CD underwent the selective operations, including 8 undergoing laparoscopic surgery (3 receiving conversion to open surgery) and 20 undergoing open surgery. Of 28 patients, 2 underwent partial upper jejunum resection, 10 underwent partial terminal ileum resection, 15 underwent right hemicolectomy and 1 underwent colectomy.Operation time and volume of intraoperative blood loss were 33-288 minutes with an average time of 122 minutes and 50-650 mL with an average volume of 200 mL, respectively. One patient had intraoperative blood transfusion. Length of intestine resected of 28 patients was 10-150 cm, with an average of 54 cm and a total length of 1 510 cm. Of 28 patients, 26 received the sidetoside anastomosis using linear closures (1 received the endtoside anastomosis using pipe stapler, 1 with multiple lesions and rectovaginal fistula received colectomy and ileostomy）. Two patients with multiple stenosis of the small intestine underwent intestinal resection combined with angioplasty for stenosis in 3 loci. Duration of postoperative hospital stay was 7-45 days, with an average duration of 15 days. No patient died of surgery. Three patients had postoperative complications, including wound infection, incisional hernia and anastomotic leakage. Twentyone patients were followed up for 3 months to 2 years, with a median time of 11 months, and there was no recurrence during the followup.
Conclusions:Surgical treatment should be performed to the patients with nonsymptom, chronic and fibrous stricturing CD and anastomotic stenosis after ineffective medical treatment, with a satisfactory outcome. Meanwhile, it need follow the principle of “minimally invasive”. And optimizing high risk factors of complications before operation is a key point for preventing postoperative complications.