Inflammation from Crohn’s disease can cause thickening or scar tissue inside your small intestine, which sometimes leads to narrow areas called strictures. A strictureplasty for Crohn’s disease is a surgery that doctors can do to widen these narrowed sections.
Strictures can cause:
With Crohn’s disease, they usually form on the lower part of the small intestine (ileum) and the valve between the small and large intestines (ileocecal valve). But you can also get them in your large intestine (colon), rectum, or anus.
Why Do Doctors Do Strictureplasty Surgery?
If a stricture is left untreated, it can lead to a blockage in your intestine that keeps poop from passing. A strictureplasty may help you avoid a more serious surgery called a small bowel resection, in which doctors remove part of your small intestine.
After you have a small bowel resection, there’s a chance you could develop short bowel syndrome (SBS). With SBS, your body can’t absorb enough fluids or nutrients because your small intestine isn’t long enough.
Doctors usually treat people with Crohn’s using strictureplasty instead of small bowel resection, if possible, to avoid this type of problem. With a strictureplasty, your intestine stays intact.
Who’s a Candidate for Strictureplasty?
This type of surgery isn’t right for everyone. But doctors are doing it on a broader range of people today than in the past.
Previously, doctors only did strictureplasty on people who had short strictures and whose Crohn’s was not flaring up at the time. Now, they do this surgery on people with:
- Several strictures on a long section of their intestine
- A previous small bowel resection
- Short bowel syndrome
- A stricture without tissue inflammation (phlegmon) or sores (fistulas)
- Repeated flare-ups of Crohn’s disease with symptoms that indicate obstruction
Your doctor probably won’t suggest a strictureplasty if you have:
- Several strictures on a short section of your intestine
- Inflammation, sores, or an abnormal growth at the stricture
- A stricture near an area that has been surgically sewn together (anastomosis)
- A hole in your bowel wall (perforated bowel)
- Malnourishment (you haven’t been getting enough nutrients)
How Do You Prepare for a Strictureplasty?
Before surgery, your doctor will likely order images of your intestines like a CT scan or magnetic resonance enterography (MRE). This helps doctors see where your stricture is, the length of your small intestine, and any other areas of concern.
You may also need a blood test to make sure you’ve been getting enough nutrients. If your nutritional levels fall short, you’ll get supplements through an IV before your surgery to help you heal better afterward.
In some cases, your doctor will create an opening in your abdomen (a stoma), to divert the flow of feces into a pouch (ostomy bag) outside your body. Your health care team will talk to you before the surgery about what to expect.
What Can I Expect During a Strictureplasty?
During a strictureplasty, your surgeon won’t need to take out any part of your intestine. They'll make a cut in your intestine at the point where the stricture is, then sew it up.
The goal is to make the affected part of your bowel wider so digested food can pass through easily. If you have more than one stricture, your doctor can often treat them all during one operation.
Strictureplasty works best in the lower parts of your small intestine, called the ileum and jejunum. It may not work as well in the upper part (duodenum).
What Are the Types of Strictureplasty?
Your surgeon can use different techniques to do your strictureplasty, depending on the length of your stricture. The most common include:
Heineke-Mikulicz strictureplasty. This technique is for short strictures (less than 10 centimeters long) and is the most common technique. After making a small vertical cut, or incision, into your intestine, they’ll put two crosswise stitches at both ends of the stricture opening. Finally, they’ll close the incision.
Finney strictureplasty. Surgeons use this technique for medium strictures (10 to 20 cm long). At the stricture site, they fold the intestine into a U shape and make a cut into the loop of the “U.” Then they stitch the edges of the bowel together.
Michelassi or side-to-side isoperistaltic strictureplasty. If you have a long stricture (more than 20 cm long), your surgeon will use this technique. They loop the affected part of your bowel at the midpoint, then put the two halves side by side. They make a long opening on both sides, then stitch them together.
What Are the Possible Complications?
For most people, strictureplasty is safe and works well. But it’s possible you’ll need more surgery later on. About 50% of people who’ve had a strictureplasty will need additional surgery.
- Potential problems during or after a strictureplasty include:
- Infection where the surgeon cuts your intestine
- A blocked bowel
- Leaking where the surgeon cut the intestine
- More strictures
One study found that 13% of people had complications after a jejunal or ileal strictureplasty.