Strictureplasty for Crohn's disease: Meta-analysis : Diseases of the Colon & Rectum (original) (raw)
Original Contributions: PDF Only
Meta-analysis
Tichansky, David M.D.1; Cagir, Burt M.D.1; Yoo, Edward B.A.2; Marcus, Sue M. Ph.D.3; Fry, Robert D. M.D.1,4
1From the Department of Surgery
Biostatistics Section, Jefferson Medical College
Philadelphia
Pennsylvania
3Division of Clinical Pharmacology
Biostatistics Section, Jefferson Medical College
Philadelphia
Pennsylvania
4_Thomas Jefferson University Hospital_
Philadelphia
Pennsylvania
2_MCP-Hahnamann School of Medicine_
Philadelphia
Pennsylvania
5Division of Colon and Rectal Surgery
Thomas Jefferson University Hospital
1100 Walnut Street, 7th Floor
19107
Philadelphia
Pennsylvania
Poster presentation at the American College of Surgeons 85th Annual Clinical Congress, San Francisco, California, October 10 to 15, 1999.
Abstract
PURPOSE:
The objective of this study was to analyze patient outcome after strictureplasty for management of intestinal stricture caused by Crohn's disease based on differences in surgical procedures.
METHODS:
A MEDLINE search was performed using a medical subject heading analysis for strictureplasty in Crohn's disease. Meta-analysis of multiple variables for outcome was performed using random-effects models.
RESULTS:
Five hundred six patients underwent 1,825 strictureplasties for Crohn's disease with minimal morbidity and zero mortality. Ninety percent of strictures were less than 10 cm in length. Approximately 85 percent of these procedures used the Heineke-Mikulicz technique and 13 percent used Finney strictureplasty. Forty-four percent of procedures included concurrent bowel resection. Recurrence rate of Crohn's disease after strictureplasty was increased in patients with longer study duration after surgery ( _P_=0.04), who showed symptoms of active disease ( _P_=0.02), who experienced preoperative weight loss ( _P_=0.02), or who received the Heineke-Mikulicz procedure ( _P_=0.008). The proportion of patients requiring additional surgery was increased with longer study duration ( _P_=0.006), with properative weight loss ( _P_=0.001), or with the Heineke-Mikulicz procedure ( _P_=0.005). The proportion of patients requiring additional surgery was decreased when a Finney strictureplasty was used ( _P_=0.008) as compared with those treated by the Heineke-Mikulicz procedure.
CONCLUSION:
Although the Heineke-Mikulicz technique is most often used for Crohn's strictureplasty, outcome analysis revealed the Finney strictureplasty may reduce the reoperation rate.
© The ASCRS 2000