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Strictureplasty for Crohn’s Disease

Strictureplasty is a type of surgery used to treat Crohn’s disease. It opens up a narrowed section of bowel.

Crohn’s Disease

Crohn’s disease may affect both the small bowel and colon. In its initial phase it may cause few or no symptoms at all. In some patients the disease manifests with inflammation in the region of the anus, resulting in the formation of fistulae and abscesses. A fistula is a tube-like tract lined with inflammatory cells. It may connect two hallow organs or open into the outer skin or the anal mucosal membrane. Fistulae are found in up to 30% of patients with Crohn’s disease.

 

Causes and risk factors of Crohn’s disease

The exact cause of Crohn’s disease is not known. Risk factors for Crohn’s disease may include:

  • Ethnicity. White people have a greater chance of getting Crohn’s disease than people of other races.
  • Family history. Having a family history of Crohn’s disease means that you are at a higher risk of developing the disease.
  • Changes in the immune system. A virus or bacterial infection may trigger an abnormal immune response, causing the immune system to attack the lining of the digestive tract in addition to the virus or bacterial infection.
  • Abnormal responsiveness to the normal intestinal bacteria.

You will undergo a health screening as well as blood tests, a chest x-ray, and an electrocardiogram (EKG) to ensure that you are healthy enough for the surgery. Please let your doctor know about all medication that you are taking as some may need to be stopped before the procedure. You will need to avoid all food and water for six to eight hours before the procedure or as recommended by your doctor.

A strictureplasty is performed under general anesthesia so you will be asleep during the surgery. The doctor will guide an inflated balloon attached to a catheter through the intestine to locate the presence of a stricture. Then, to open up the stricture, an incision will be made lengthwise along the length of the stricture. The doctor will then sew the incision in the opposite direction (width-wise) to widen the stricture without removing any bowel. Multiple strictures can be treated during one surgery.

 

Most patients who undergo strictureplasty must stay in the hospital for up to 10 days. You will need to continue taking your medication for Crohn’s disease as well as return to your routine for managing your symptoms. You will likely be able to return to normal activities once you are discharged, but will need to wait six weeks for more strenuous activities. Your doctor will provide instructions regarding when you can resume different activities. Strictureplasty is considered effective for relieving symptoms of Crohn’s disease, but there is still a chance of recurrence, which would require another surgery.

  • Abdominal bleeding.
  • Infection.
  • Bowel obstruction.
  • Fistula.
  • Abscess.
  • Recurrence.
  • Reaction to anesthesia.
  • If you are taking any blood-thinning medication/anticoagulant, please let your doctor know as some may need to be stopped before you travel for the procedure.
  • Travelers to Thailand should plan to stay in the country for at least two to three weeks or for the entire duration of treatment.
  • If you plan to return home after the procedure, please speak to your doctor before making travel arrangements.
  • During your follow-up appointment your medical team will assess your health and your incision and you will receive documents detailing your medical and treatment history and your "Fit to Fly" certificate (if needed).

The success of the procedure depends on a number of factors. Please discuss the likelihood of success with your doctor before the procedure.

 

What if this procedure is not performed?

Crohn’s disease can have debilitating symptoms and lead to life-threatening complications if not managed with medication, lifestyle changes, and, in some cases, surgery. Symptoms can interfere greatly with normal life.

Medication and nutritional therapy are usually the first options for treatment of Crohn’s disease. If those are not effective in managing your symptoms, surgery is then considered. Other than a strictureplasty, your doctor may recommend surgery to remove the damaged portion of your digestive tract. The remaining intestine is then attached to another healthy section. Keep in mind that even with surgery, medication is still necessary to manage the disease.

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