How Do You Treat Small Bowel Narrowing?

Strictureplasty can be used to treat simple or short strictures.

Strictureplasty can be used to treat simple or short strictures. In this procedure, the damaged portion of the intestine is cut open and reshaped. For long and complicated strictures, surgical removal of the affected part of the bowel (resection) should be considered.

What are strictures?

Strictures are narrowed parts in the intestine that often leads to bowel obstruction. 

Factors causing strictures are as follows:

• Tuberculosis
• Inflammatory bowel disease such as Crohn's disease
• Cancer
• Infections
• Previous surgery

What is strictureplasty?

Strictureplasty is a surgical procedure to repair strictures by enlarging the narrowed area without removing any portion of your intestine. Strictureplasty is a well-established treatment for Crohn’s disease. 

Strictureplasty is generally a safe procedure and is most effective in treating lower sections of the small intestine called the ileum and jejunum.

Why is strictureplasty done?

Strictureplasty is performed under the following conditions:

• Multiple strictures in the long segment of the bowel
• A previous resection surgery (surgical removal of more than 100 cm of the small bowel)
• Rapid reoccurrence of Crohn’s disease with obstructive symptoms
• Obstructive small bowel strictures without associated sepsis formation

How is strictureplasty performed?

Strictureplasty depends on various factors:

• Length of strictures
• Positioning of strictures within the small intestine
• Number of strictures present

Strictureplasty techniques depend on the length of strictures, which are as follows:

• For short strictures (less than 10 cm in length), the Heineke Miulicz strictureplasty technique is used.
• For medium strictures (10-20 cm in length), the Finney strictureplasty technique is used.
• For long strictures (longer than 20 cm in length), the side-to-side isoperistaltic strictureplasty technique is used.

Heineke Miulicz technique:

• Strictureplasty is performed under general anesthesia or local anesthesia.
• An incision (surgical cut) is made along the bowel that is slightly longer than strictures.
• The incision is transverse (perpendicular) to the stricture length.
• Two stitches are placed at the ends of the opening of strictures.
• The incision is closed using absorbable sutures.
• This causes widening of strictures.

Finney strictureplasty technique:

• The intestine is folded at the stricture site.
• A U-shaped incision is made along strictures without disturbing the adjacent healthy tissues.
• Strictures are sealed by stitching it side-to-side creating a widened passage in the intestine.

Jaboulay (side-to-side isoperistaltic) technique:

• This is done where the opening is too narrow.
• The intestine is folded at the stricture site.
• Two short incisions are made along strictures without disturbing the adjacent healthy tissues.
• In this, a bypass is created around strictures.

How do you treat strictures in Crohn’s disease?

Inflammatory bowel disease such as Crohn’s disease can lead to scarring within your intestines. Over time, this can lead to narrow sections in your bowels (strictures). Surgery is needed to widen strictures to remove an obstruction.

Strictureplasty does not involve the removal of any part of the intestine, and hence, it is a bowel-preserving surgery. Strictureplasty reduces the risk of short bowel syndrome, which is usually the complication of resection surgery.

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What are the complications of strictureplasty?

As with any surgery, complications are inevitable with strictureplasty. Some uncommon possible complications caused due to strictureplasty are as follows:

• Infection at the surgical incision
• Bowel obstruction
• Bleeding in your bowel
• Fluid leaking from the stitches
• Recurrence of strictures

When should strictureplasty be avoided?

Strictureplasty should be avoided in the following conditions:

• Inflammation, swelling, or hole at the affected site
• Strictures close to a planned surgical site
• Multiple strictures in a short segment of the bowel
• Any stricture with cancerous cells