%0 Journal Article
%T Resection Leads to Less Recurrence Than Strictureplasty in a Paediatric Population with Obstructive Crohn¡¯s Disease
%A Richard Bamford
%A Ashley Hay
%A Devinder Kumar
%J Surgery Research and Practice
%D 2014
%R 10.1155/2014/709045
%X Introduction. Resection and strictureplasty are used to treat patients with obstructive Crohn¡¯s disease. Strictureplasty is preferable in adults as it retains bowel length. This study aims to identify differences in outcomes of children undergoing strictureplasty and resection for obstructive Crohn¡¯s disease. Method. Patients under 20 years undergoing surgery over a nine-year period were included. Data was collected on procedures for stenotic Crohn¡¯s disease. Patients were divided into 2 groups: Group 1 treated with strictureplasties and Group 2 resections. Postoperative complications and recurrence rates were recorded. Kaplan-Meier method was used to analyze the data. Results. Twenty-six patients and 40 operations were identified. Mean age was 15.6 years (7.2¨C19.4) with equal numbers of males and females. Mean follow-up was 45.9 months (0.1¨C149.9). 20/40 procedures involved the terminal ileum; 9/40, the ileocolic junction; 8/40, the upper GI tract; and 3/40, the colon. Group 1 consisted of 19 strictureplasties and Group 2 consisted of 13 resections and 8 combined procedures. Significantly more patients in Group 1 required further surgery (11/19 versus 3/21; ). Conclusion. Allowing for variations in disease duration, severity, and previous medical management, these data suggest that resection is preferable to strictureplasty in treating obstructive Crohn¡¯s disease in children and adolescents. 1. Introduction Children and adolescents account for 25% of all patients with Crohn¡¯s disease and can have a significant impact on growth and development [1]. Over their lifetime, affected patients have a 70¨C90% chance of surgical intervention [2, 3]. Furthermore, recrudescence of the disease requiring additional surgical intervention can occur in 50% of patients [4, 5]. Indications for surgical intervention in Crohn¡¯s disease include perforation, abscess formation, bleeding, malignancy, and fibrotic strictures [6]. This study aims to concentrate on the outcomes of patients treated for the latter of these indications. Strictureplasty and resection are both used to treat obstructive Crohn¡¯s disease. First described in the 1970s as a treatment for tuberculosis, strictureplasty was employed for the management of Crohn¡¯s strictures in the early 1980s [7, 8]. The indications for its use are to preserve small bowel length in patients who would otherwise require a large resection, single site fibrotic strictures in inactive disease, recurrence of strictures less than 1 year since resection, isolated ileocolonic strictures, and selected duodenal strictures [9, 10]. The
%U http://www.hindawi.com/journals/srp/2014/709045/