Intestinal strictures are a common complication of Crohn’s disease. Strictures are a narrowing of a specific section of your intestine that makes it difficult for food to pass through. They may sometimes lead to intestinal blockage.
Strictureplasty is a type of surgery used to correct strictures in your digestive tract. In this article, we’ll take a look at the procedure, risks, and recovery.
Strictureplasty is a surgical treatment for intestinal strictures. It involves widening damaged parts of your intestines. If multiple strictures are present, they can be treated at the same time.
The authors of a 2007 meta-analysis of 3,529 strictureplasties concluded that strictureplasty is a safe and effective treatment for strictures in the lower part of your small intestine, including the ileum and the jejunum. Strictures caused by Crohn’s disease typically occur here.
Strictureplasty is less effective at treating strictures in the upper part of your small intestine or duodenum, which are more likely to be caused by ulcers.
In a strictureplasty, no parts of your small intestine have to be removed. This helps to avoid a complication called short bowel syndrome, which can limit the absorption of water and nutrients.
Strictures are caused by inflammation of your digestive tract. They’re a common symptom of Crohn’s disease, but can also be caused by:
- past surgeries
- certain types of cancer
Over time, chronic inflammation causes your intestinal walls to thicken into scar tissue, forming a stricture. Strictures are narrower than healthy intestinal tissue. If left untreated, they can block the passage of food matter through your digestive tract.
During a strictureplasty, a surgeon opens your abdomen and makes a series of cuts along the length of the stricture. The damaged tissue is then restructured and resewn to allow for a wider opening.
Prior to the surgery, you might be asked to undergo tests to determine your nutritional health. If you are malnourished, your doctor might prescribe vitamins or supplements to be taken before and after the strictureplasty.
Before the procedure
Colorectal surgeons use computed tomography (CT) or magnetic resonance imaging (MRI) scans to identify the size, number, and location of strictures. Before the procedure, your surgeon will explain in detail the technique they will use.
The day before the surgery, you might be asked to take a laxative to empty your bowels. In other cases, an enema is given prior to the surgery to make sure your bowels are clear.
During the procedure
On the day of the surgery, a nurse will check your vital signs and prepare you for the operation.
Strictureplasty is usually done under general anesthetic. You will be unconscious and you shouldn’t be able to feel anything. An anesthesiologist will explain the risks and side effects.
The surgeon will make an incision to open your abdomen. The surgical technique used to treat your stricture(s) depends on the length of the stricture.
The most commonly used strictureplasty techniques include:
- Heineke-Mikulicz strictureplasty. This technique is used for short strictures, typically less than 10 cm in length. It is the most common strictureplasty technique.
- Finney strictureplasty. This technique is used for strictures that are between 10 and 20 cm in length.
- Michelassi strictureplasty. Also known as side-to-side isoperistaltic strictureplasty, this technique is used for strictures that are greater than 20 cm in length.
Sometimes, surgeons use a combination of these techniques. According to a 2012 meta-analysis of 4,538 strictureplasties, both conventional and nonconventional techniques for strictureplasty had similar rates of complications.
After the strictureplasty is finished, the surgeon will close the incision site.
Recovery from strictureplasty generally depends on both your health prior to the surgery and how effective the surgery is.
You can expect to remain in the hospital for around a week following the procedure so that your healthcare professional can monitor your condition. During this time, you will be given medication for pain and any side effects of the anesthetic.
Before you go home, you’ll receive additional instructions to help with your healing process. For instance, you might be asked to avoid driving or housework. Your doctor may suggest a light diet of low-fiber foods and prescribe medication and supplements to help restore your digestive function.
It may be several months before you fully recover. As you regain your strength, you should notice an improvement in your symptoms.
As with any surgery, strictureplasty comes with a risk of complications. The most common complications include:
- gastrointestinal bleeding
- reappearance of the stricture
- infections at the incision site
- bowel obstruction
- temporary changes in intestinal function
According to the 2007 meta-analysis mentioned above, the rate of complications for strictureplasties of the lower small intestine was approximately 13 percent.
Seek medical attention right away if you experience any of the following:
- severe pain
- severe constipation or diarrhea
- extreme weakness
- infection at the wound site
Strictureplasty is a surgical procedure used to treat strictures in your gastrointestinal tract.
Strictures occur when the walls of your small intestine become thicker due to chronic inflammation. This causes a narrowing of your small intestine that can obstruct the passage of food through your digestive tract.
Strictureplasty is a preferable option for people who may have had previous bowel resections and are at risk of developing short bowel syndrome.
Talk with your doctor to discuss the risks and benefits of this procedure, and to determine whether strictureplasty might be a good option for you.