Crohn’s diseases is classified as one type of inflammatory bowel disease. It usually affects the small bowel and colon. Crohn's disease affect patients due to the ability to cause chronic inflammation. Chronic inflammation may lead to complications in the intestines such as obstruction, fistulae, abscess and strictures. Obstruction usually occurs as a result of strictures or adhesions that narrrow the lumen of the small intestine. In patients who are affected by Crohn's disease that experience obstruction due to strictures, two treatment approaches can be taken; resection of that particular portion of the bowel or a stricture plasty. A strictureplasty is a surgical procedure to repair a stricture by widening the narrowed area without removing any portion of your intestine. If the obstruction of the small intestine is not too extensive and that portion of the bowel can still be salvaged, surgeons would usually recommend a strictureplasty as the preferred choice of treatent.
A strictureplasty will allow the surgeon to restore free flow through the bowel without the need for removing bowel segments (i.e., without bowel resection).
-Strictureplasty does not involve resecting the affected section of the small intestine. This will allow patients to retain their small intestine and thereby preserving its functions of digestion and absorption of nutrients.
-A Strictureplasty is not as radical as small bowel resection and usually comes with fever complications.
-Data shows that strictureplasty has a protective effect on disease recurrence.
-A strictureplasty may cause slight discontinuities in peristalsis, due to reconfiguration of the bowel.
-Despite how effective strictureplasties are in relieving symptoms of Crohn’s disease, there is still a chance of recurrence, which might require subsequent surgery.
The type of strictureplasty that your surgeon will depend on many factors, which include; the length of your strictures, the location of the stricture and the number of strictures present. The strictureplasty will be performed under general anesthesia. The doctor will guide an inflated balloon attached to a catheter through the intestine to locate stricture. 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.
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.
Most patients who undergo strictureplasty stay in the hospital for an average of 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.
As with any procedure it's possible for complications to happen.
Possible complications associated with strictureplasty include:
-Infection in your surgical incision
-Bleeding in your bowel
-Fluid leaking from the stitches in your bowel
-Additional strictures may form over time
Can strictures and adhesions occur again even after with surgery?
Unfortunately, the answer is yes. There are things which patients with Crohn's disease can look after to reduce the inflammation in the bowels. Diet also plays a role in the progression of Crohn’s disease. Gluten based products such as wheat, barley, and rye, can trigger inflammation in the GI tract. Continual exposure to gluten can result in chronic inflammation that can eventually lead to strictures. People who have Crohn’s disease can manage their symptoms and reduce inflammation by adopting a gluten-free diet or avoiding difficult-to-digest foods, such as meat and dairy.
Thus, people who have one or more intestinal strictures may benefit from the following dietary changes:
1. Consume small meals more frequently
2. Eating cooked vegetables and fruits without skin
3. Avoiding foods that may upset the digestive system, such as meat, dairy, nuts, and beans.
What causes strictures in patients with Crohn's disease?
Chronic inflammation can lead to changes in the intestinal lining resulting in the accumulation of scar tissue, collagen, and fibrous material. Prolonged accumulation of these structures will cause the intestinal wall to thicken, slowly and eventually causing intestinal obstruction in the lumen.