Strictureplasty is surgery to repair a narrow passage, known as a stricture, in the bowels. Strictures may develop as a result of diseases that cause inflammation of the bowels, such as Crohn’s disease and ulcerative colitis.
Strictureplasty may alleviate painful or uncomfortable digestive symptoms, reduce the risk of a potentially dangerous intestinal blockage, and improve quality of life. However, the procedure does carry the risk of complications.
In this article, we describe what a strictureplasty is, when the procedure may be necessary, and the potential benefits and risks. We also provide information on recovery time and alternative surgical procedures for strictures.
Inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, can damage the intestines. Over time, this damage can lead to the buildup of scar tissue, which causes the intestines to narrow. Doctors refer to this narrowing as a stricture.
Strictures may cause various symptoms, such as:
- digestive pain or discomfort
- abdominal cramping
- abdominal bloating and gas
Strictures increase the risk of an intestinal blockage or obstruction. Partial intestinal blockages can cause uncomfortable or even painful digestive symptoms. Complete intestinal blockages can prevent food from passing through the intestines, and this can lead to serious and potentially life threatening complications.
Strictureplasty widens strictures, thereby alleviating the symptoms that they cause and reducing the risk of serious intestinal blockages.
A strictureplasty widens strictures in the intestines, which can have the following benefits:
- alleviating uncomfortable or painful digestive symptoms
- reducing the risk of serious and potentially life threatening intestinal blockages
- improving quality of life
Strictureplasty is more successful in treating strictures in the middle and lower portions of the small intestine: the jejunum and ileum, respectively. The procedure is less likely to produce a good outcome when the strictures are in the upper small intestine, the duodenum.
The alternative to strictureplasty is a procedure called bowel resection, which removes part or all of the affected bowel. Strictureplasty may be preferable to bowel resection, as it is
Short-term complications can occur during or shortly after strictureplasty. They may include:
- anesthesia-related complications
- a bowel obstruction
- intestinal leakage
- sepsis, which is a serious systemic infection that can become fatal
A longer term risk of strictureplasty is the potential need for follow-up surgery in the future. People who undergo bowel resection are less likely to require subsequent surgeries than those who do not but more likely to develop SBS.
Strictureplasty is an inpatient procedure, meaning that a person must stay in the hospital for the treatment.
Before the surgery, a person will receive a general anesthetic via an IV line in their hand or arm. General anesthesia ensures that the person remains entirely pain-free and unconscious throughout the procedure and that they have no memory of the procedure when they wake up.
The specific surgical technique varies slightly depending on the type of procedure. However, all methods involve cutting into the intestines and then widening the stricture using a series of stitches. The specific technique that a surgeon chooses will depend on the size and location of the strictures. The
- Heineke-Mikulicz technique: This technique is most effective for strictures shorter than 10 centimeters (cm) in length.
- Finney technique: This is most effective for strictures that are 10–20 cm in length.
- Side-to-side isoperistaltic strictureplasty: This is most effective for strictures that are longer than 20 cm.
Following surgery, a person may experience some pain in the abdomen. Depending on the type of procedure they have undergone, they may also need an ostomy bag to collect bowel movements while they recover.
Strictureplasty is a major surgery that generally has a relatively long recovery time. Research suggests that a person should expect to stay in the hospital for about 9 days following extensive strictureplasty. However, people who experience complications may need to stay longer, and those with shorter strictures may be able to go home after a shorter stay.
During the early days of recovery, a person may need help moving around, and they will probably require pain medication. The individual may not be able to drive or lift heavy objects for several weeks.
- intense pain
- discoloration or warmth at the surgical site
- unusual drainage from the wound or into an ostomy bag
In some cases, a person may need to meet with a dietitian or follow a special diet to reduce the risk of complications and the need for additional surgery. They will also need to continue with other treatments for IBD, as strictureplasty does not cure the underlying cause of strictures.
A person should notice an improvement in their digestive symptoms several weeks after the surgery. If the symptoms persist or worsen, this could be a sign that the surgery was not successful.
A strictureplasty attempts to preserve the full length of the intestines by widening strictures. In comparison, a bowel resection removes the part or parts of the bowel that strictures have affected.
According to a 2020 meta-analysis, the risk of developing SBS is lower with strictureplasty than with bowel resection.
However, people who undergo bowel resection are less likely to require additional bowel surgery in the future. For this reason, the study authors recommend strictureplasty only for people who are at high risk of SBS or intestinal failure. They state that bowel resection may be the better option for most other people.
Strictureplasty is surgery to widen strictures, which are narrowed sections of the bowel. This surgery can help alleviate uncomfortable or painful symptoms of strictures, reduce the risk of intestinal blockages, and improve quality of life.
Some people may experience short-term complications during or following strictureplasty, such as bleeding, infection, or intestinal leakage. In addition, most people who undergo the procedure will require further surgery at some point in the future.
People who are considering strictureplasty should talk with a doctor about the potential risks and benefits of the procedure. They may also wish to discuss alternative options, such as bowel resection surgery.