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International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 4/2020

01-04-2020 | Crohn's Disease | Original Article

Strictureplasty versus bowel resection for the surgical management of fibrostenotic Crohn’s disease: a systematic review and meta-analysis

Authors: Waqas T. Butt, Éanna J. Ryan, Michael R. Boland, Eilis M. McCarthy, Joseph Omorogbe, Karl Hazel, Gary A. Bass, Paul C. Neary, Dara O. Kavanagh, Deirdre McNamara, James M. O’Riordan

Published in: International Journal of Colorectal Disease | Issue 4/2020

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Abstract

Background

Strictureplasty (SPX) conserves bowel length and minimizes the risk of developing short bowel syndrome in patients undergoing surgery for Crohn’s disease (CD). However, SPX may be associated with a higher risk of recurrence compared with bowel resection (BR).

Aim

We sought to compare morbidity and recurrence following SPX and BR in patients with fibrostenotic CD.

Methods

A systematic review was performed according to PRISMA and MOOSE guidelines. Observational studies that compared outcomes of CD patients undergoing either SPX or BR were identified. Log hazard ratios (InHR) for recurrence-free survival (RFS) and their standard errors were calculated from Kaplan–Meier plots or Cox regression models and pooled using the inverse variance method. Dichotomous variables were pooled as odds ratios (OR) using the Mantel–Haenszel method. Continuous variables were pooled as weighted mean differences.

Results

Twelve studies of 1026 CD patients (SPX n = 444, 43.27%; BR with or without SPX n = 582, 56.72%) were eligible for inclusion. There was an increased likelihood of disease recurrence with SPX than with BR (OR 1.61; 95% CI, 1.03, 2.52; p = 0.04; I2 = 0%). Patients who had a SPX alone had a significantly reduced RFS than those who underwent BR (HR 1.47; 95% CI, 1.08, 2.01; p = 0.02; I2 = 0%). There was no difference in morbidity between the groups (OR 0.58; 95% CI, 0.26, 1.28; p = 0.18; I2 = 0%).

Conclusion

SPX should only be performed in those patients with Crohn’s strictures that are at high risk for short bowel syndrome and intestinal failure; otherwise, BR is the favored surgical technique for the management of fibrostenotic CD.
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Metadata
Title
Strictureplasty versus bowel resection for the surgical management of fibrostenotic Crohn’s disease: a systematic review and meta-analysis
Authors
Waqas T. Butt
Éanna J. Ryan
Michael R. Boland
Eilis M. McCarthy
Joseph Omorogbe
Karl Hazel
Gary A. Bass
Paul C. Neary
Dara O. Kavanagh
Deirdre McNamara
James M. O’Riordan
Publication date
01-04-2020
Publisher
Springer Berlin Heidelberg
Keyword
Crohn's Disease
Published in
International Journal of Colorectal Disease / Issue 4/2020
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-020-03507-z

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