Improving Surgery for Crohn's Disease

Fabrizio Michelassi--now professor of surgery at Weill Cornell Medical College (New York, NY, USA)--examined data collected by Dr. Michelassi during nearly 20 years (1984-2004) of his tenure at the University of Chicago. Dr. Michelassi was able to keep records on 981 patients who underwent a total of 1,132 procedures, 668 of which involved recurrent disease. During each procedure, he took pictures and made detailed sketches of those areas subject to surgery.

The study revealed several insights: First of all, it validated the notion that strictureplasty--a bowel-sparing surgical procedure commonly used to correct Crohn's-related strictures--carries a lower risk of stricture recurrence compared to resection, and that if a recurrence does occur after strictureplasty, it is likely to happen much later than after resection. The study found that recurrences after strictureplasty were also less likely to require a surgical excision of the affected area compared to recurrences occurring after resection. The study also found that up to a third of recurrences occur away from the site of the original operation. Among other findings, the study supports the notion that strictureplasty is less likely to lead to stricture recurrence later on, compared to surgical resection of the stricture.

"Based on our findings, we would now advise that if an asymptomatic stricture can be fixed using bowel-sparing strictureplasty, then the surgeon should go ahead and perform that type of prophylactic procedure,” said Dr. Michelassi. "However, if fixing the problem requires bowel resection, then we would advise leaving the stricture alone, because there's still a 75% chance it will not cause the patient any harm.”

Crohn's disease involves a chronic inflammation of the digestive tract, often resulting in pain and diarrhea. Disease onset typically occurs in young adulthood, and the disorder is characterized by strictures--narrowings of the bowel--that often require surgical excision or correction. There is currently no cure for Crohn's.


Related Links:
University of Chicago
Weill Cornell Medical College