Strictureplasty
Chronic inflammation from inflammatory bowel disease can cause scar tissue or thickening inside your small intestine. This damage can lead to narrow areas called strictures. Strictures can cause a range of uncomfortable and painful symptoms. A strictureplasty can help relieve these symptoms and prevent the possibility of an intestinal blockage.
Strictureplasty is surgery to widen a narrow section of your intestines called a stricture. Chronic inflammation due to inflammatory bowel disease (IBD), like Crohn’s disease and ulcerative colitis, can lead to strictures. Strictures typically form on the lower part of your small intestine (ileum) and the valve between your large and small intestines (ileocecal valve). But they can also develop in your large intestine (colon), rectum or anus (butthole).
Strictureplasty can help relieve uncomfortable or painful digestive tract symptoms. It can also reduce your risk of an intestinal blockage and improve your quality of life. But strictureplasty does carry a risk of complications like bleeding, infection and intestinal leakage. So, it’s important to talk to your healthcare provider to weigh the benefits against the risks.
Inflammation from inflammatory bowel disease can cause tissue scarring or thickening inside your small intestine. This damage can lead to narrow areas called strictures. Strictures can cause a range of uncomfortable and painful symptoms, including:
- Severe abdominal pain and cramping.
- Bloating and gas.
- Nausea and vomiting.
- Constipation.
- Lack of appetite and weight loss.
- Fatigue and anemia. (The strictures often have ulcers in them that cause you to slowly lose blood and become anemic. These usually go away after the strictureplasty.)
Strictures can also increase your risk of an intestinal obstruction or blockage. Partial intestinal blockages can cause the same symptoms as intestinal narrowing. Complete intestinal blockages can prevent digested food from passing through your intestines. This can lead to serious, life-threatening complications.
Strictureplasty isn’t for everyone. But healthcare providers are performing it more often than they did in the past. You may be a good candidate for strictureplasty if you have:
- More than one stricture on a long section of your intestine.
- A previous small bowel resection.
- Short bowel syndrome.
- A stricture without tissue inflammation or sores.
- Repeated flare-ups of Crohn’s disease with symptoms that point toward a blockage.
Your provider probably won’t recommend a strictureplasty if you have:
- More than one stricture on a short section of your intestine.
- Sores, inflammation, fistulas or an abnormal growth at the stricture.
- A stricture near a section that was surgically reconnected (anastomosis).
- A hole in your intestinal wall (perforated bowel).
- Malnourishment.
Before the procedure, your healthcare provider will want to see your intestines through imaging tests like a CT scan (computed tomography scan) or magnetic resonance enterography. This helps your provider see where your stricture is and the length of your small intestine. They can also note any other areas of concern.
Your provider will likely request a blood test to make sure you’re getting enough nutrients. If your nutritional levels are low, you’ll get supplements through an IV (intravenously, through a vein) before the procedure to help you heal better afterward.
Depending on your situation, your provider may create an opening in your abdomen (stoma) to divert your poop into a pouch (ostomy bag) outside your body. Your healthcare provider will talk to you before the procedure so you know what to expect.
Strictureplasty is a major surgery, and you’ll have to stay at the hospital after the procedure. Before surgery, you’ll receive general anesthesia to make you go to sleep. This ensures that you’ll remain pain-free throughout the procedure, and you’ll have no memory of it when you wake up.
During the procedure, your surgeon will make a cut lengthwise down the stricture and then widen it using stitches. The goal is to make the affected part of your intestine wider so digested food can pass through more easily. If you have several strictures, your provider can usually treat them all during one operation.
There are several different types of strictureplasty. Which type you receive varies based on the size and location of the stricture. Types of strictureplasty include:
Heineke-Mikulicz strictureplasty
Healthcare providers use this type, pronounced “HI-nik-ee Mik-yoo-lits,” for strictures shorter than 10 centimeters (cm) (about 4 inches) long. It’s the most common type by far. After making a small, vertical cut (incision) into your intestine, your surgeon will put two crosswise stitches at both ends of the stricture opening. Then, they’ll close the incision.
Less common strictureplasties
- Finney or Jaboulay strictureplasty: Providers use this type for medium-size strictures that are 10 cm to 20 cm (about 8 inches) long. At the stricture site, they fold your intestine into a “U” shape and make an incision into the loop of the “U.” Then, they stitch the edges of your intestine together.
- Michelassi (“MIK-el-LASS-ee”) or side-to-side isoperistaltic strictureplasty: Providers use this type for strictures that are longer than 20 cm (about 8 inches). Your surgeon will loop the affected part of your intestine at the midpoint. Then, they’ll put the two halves side by side. They’ll cut a long opening on both sides and then stitch them together.
After surgery, you may experience some pain in your abdomen. Depending on the type of procedure, you may also need an ostomy bag to collect your poop while you recover.
The duration of a strictureplasty procedure varies based on your condition, but you can typically expect it to take two to six hours.
A strictureplasty has many potential benefits, including:
- Alleviating painful or uncomfortable digestive symptoms.
- Reducing your risk of a serious and potentially life-threatening intestinal blockage.
- Improving your quality of life.
Strictureplasty is most successful in treating strictures in the middle portion (jejunum) and lower portion (ileum) of your small intestine. The procedure isn’t as likely to help when the stricture is in your upper small intestine (duodenum).
For most people, strictureplasty is safe and effective. But short-term complications can occur during or after strictureplasty. They may include:
- Anesthesia-related complications.
- Bleeding.
- Infection.
- Bowel obstruction (blockage).
- Intestinal leakage.
- More strictures.
- Sepsis.
One study on strictureplasty for Crohn’s disease reported an overall complication rate of 13% and a sepsis rate of 4%.
The long-term risk of the procedure is the potential need for follow-up surgery in the future. About 50% of people who’ve had a strictureplasty will need another surgery.
Strictureplasty is a major surgery that usually has a long recovery time. Studies state that you should expect to stay in the hospital for about a week following the surgery. But if you have complications, you may need to stay longer. If you have a shorter stricture, you may be able to go home sooner.
During the early days of your recovery time, you may need help moving around. You’ll likely need pain medication. You won’t be able to lift heavy objects or drive for several weeks.
Depending on your stricture, you may need an ostomy. This is a bag that removes waste from your intestines. You’ll need to learn how to care for the ostomy to prevent infection. Signs of infection include:
- Severe pain.
- Fever.
- Warmth or discoloration at the surgical site.
- Unusual drainage into an ostomy bag or from the wound.
Depending on your situation, you may need to follow a GI (g soft diet or meet with a dietitian to reduce the risk of complications and the need for another surgery. You’ll also need to continue with your other treatments for IBD. Strictureplasty doesn’t cure the underlying cause of strictures.
You should notice an improvement in your digestive symptoms several weeks after the surgery. If the symptoms persist or get worse, it could be a sign that the procedure wasn’t successful.
References
- Crohn’s and Colitis Foundation (U.S.). Strictureplasty (https://www.crohnscolitisfoundation.org/patientsandcaregivers/what-is-crohns-disease/treatment/surgery/strictureplasty). Accessed 4/17/2024.
- Hoilat GJ, Rentea RM. Crohn Disease Stricturoplasty (https://pubmed.ncbi.nlm.nih.gov/32809432/). 2023 Jul 25. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. Accessed 4/17/2024.
- Strong SA. Strictureplasty in Complex Crohn’s Disease: Beyond the Basics (https://pubmed.ncbi.nlm.nih.gov/31308832/). Clin Colon Rectal Surg. 2019 Jul;32(4):243-248. Accessed 4/17/2024.
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