Strictureplasty

A strictureplasty procedure is a surgical treatment procedure. This is used to remove scar tissue that are found developing in the intestinal walls as a result of inflammatory bowel conditions such as Crohn’s disease.

A bowel inflammatory disease may cause the intestinal passage to become blocked, or narrowed. This can cause the bowel contents to be forced into ulcers and fissures in the narrowed intestine and cause additional complications and damage to the intestine and digestive functions. A strictureplasty aims to restore free movement of the bowels inside the intestine through widening the narrowed intestine with resection and reattachment of the bowel.

Do I need a Strictureplasty?

A strictureplasty surgical procedure is aimed at treating the following conditions:

  • Narrowing of bowel at multiple places along a single bowel segment
  • A resection of more than 100 cm of the small bowel has been performed previously
  • Crohn’s disease is seen recurring with higher frequency with bowel obstruction
  • Fibrotic small-bowel stricture with obstructing (but without associated sepsis) is seen

Strictureplasty is not used as a treatment method in case there is:

  • Phlegmon, internal fistula or perforation at the damaged site
  • Stricture is in close proximity to a planned anastomotic site
  • Multiple stricture in a short segment of bowel
  • A stricture with signs of dysplasia or malignancy

Who is an ideal candidate for a Strictureplasty?

An ideal candidate for a common strictureplasty is a person affected with a bowel-obstructive disorder who is in a physically fit condition to undergo a surgical procedure. The person should be free from any other serious underlying medical disease or disorder to avoid further complications from arising due to the surgery.

The doctor/surgeon will perform certain diagnostic tests to determine if you are ideal to receive a strictureplasty treatment procedure, such as computerized tomography (CT) scan, magnetic resonance enterograpy, etc as well as to determine the extent of the damage and obstruction in the intestines.

How is a Strictureplasty performed?

A strictureplasty is a major type of surgical procedure that is ideally used to treat a large number of medical diseases and disorders that mainly cause bowel obstruction in the intestine. This is performed using a number of different approaches and is classified depending on the length of the stricture mainly.

A strictureplasty procedure mainly follows these basic steps:

  • The bowel is cut (incised) along the antimesentric border
  • Enterotomy must be elongated a further 1-2 cm to the proximal and distal of the diseased bowel segment
  • Any abnormal growth needs to be removed to prevent chances of cancer
  • Hemostasis should be maintained well

The type of strictureplasty procedures are:

Heineke-Mikulicz Strictureplasty

This variation of the strictureplasty procedure requires making a longitudinal incision along the antimesenteric border of the bowel. This incision is extended further towards the distal and proximal directions by 1-2 cm in the diseased segment to the normal bowel.

The surgeon will place 2 stay sutures at the opening ends of the stricture and then pull the stay sutures perpendicularly to the long axis of the bowel. The enterotomy is closed using various types of sutures in the transverse mucosal layers.

A modified version of this surgical procedure requires placing two short-segment strictures close to each other in the small bowel. The surgeon makes a single enterotomy passing both the strictures are well as the normal intervening segment. The surgeon then closes the enterotomy using a transverse method as is seen in the normal Heineke-Mikulicz strictureplasty.

Finney Strictureplasty

This strictureplasty method requires making a medium-length (10-20 cm) stricture. The surgery involves folding the bowel at the stricture site and bringing the normal distal and proximal bowel together. The surgeon will then open the strictured segment along the antimesenteric border and is then closed in a sideways manner with hand-sewn anastomosis.

Jaboulay Strictureplasty

This variation of the strictureplasty procedure is useful for bypass of strictures in which the lumen is significantly narrow and obstructs the normal passage of the food contents in the bowel. This is also useful in cases where the bowel wall at the stricture site is not suitable to hold the suture line.

This surgery requires the surgeon to fold the small bowel at the stricture site in order to bring together the normal proximal and distal small-bowel segments. The surgeon will then open up the normal bowel segments at the antimesenteric border and hand-sewn to be attached to each other in two separate layers.

What are the complications associated with a Strictureplasty?

There are certain surgery-related complications that are seen in rare cases of strictureplasty (as is seen in many other surgical procedures) such as:

  • Pain
  • Bleeding (hemorrhage)
  • Infection
  • Anesthetic allergy

The strictureplasty procedure also may show rare complications such as:

  • Stricture recurrence
  • Abscess
  • Fistula
  • Bowel obstruction

 

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