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Strictureplasty for Treatment of Crohn's Disease: a NSQIP Database Analysis
Cristina N. Budde*, J. Isaac Young, Brian S. Diggs, Kian Keyashian, Kim C. Lu, Vassiliki L. Tsikitis, Daniel O. Herzig
Oregon Health and Science University, Portland, OR
Background:
Strictureplasty has been proposed as a good alternative to small bowel resection for the treatment of Crohn's Disease (CD) related strictures. It has the advantage of preserving bowel length, and specialized centers have reported favorable results with the operation. However, the actual utilization of this procedure in the United States is thought to be low, and the Residency Review Committee (RRC) has recently removed strictureplasty from the required case experience for residents in Colon and Rectal Surgery programs. Using a large national database, we sought to determine the use and outcomes of strictureplasty and small bowel resection in the treatment of Crohn's patients.
Methods:
We examined the ACS-NSQIP database from the years 2005-2012. All patients who underwent an elective small bowel resection and/or strictureplasty for Crohn's disease were examined. We examined trends in utilization and compared outcome variables for small bowel resection alone (SBR) to strictureplasty with or without SBR. Cohort outcomes were compared using Pearson test and Kruskal-Wallis test.
Results:
We identified 1202 CD patients who underwent elective surgical intervention consisting of small bowel resection, strictureplasty, or both. Comparing 2005 to 2012, the proportion of patients undergoing strictureplasty decreased over time (30 vs 17%). Comparing outcome variables, median operative time was shorter in patients with SBR than strictureplasty (158 vs 177 min, p=0.001), yet organ space SSI occurred more frequently with SBR than with strictureplasty (6 vs. 3%, p<0.001). Superficial surgical site infection (SSI), deep SSI, reoperation rate and readmission within 30 days were no different between the groups.
Conclusion:
The use of strictureplasty as an elective intervention for CD related strictures is decreasing in the ACS-NSQIP database. Short term surgical outcomes are similar between strictureplasty and SBR. Since strictureplasty has a decreased risk of organ space infection and preserves bowel length, this procedure may be underutilized.
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