Decades of painstaking research has yielded the most in-depth look ever at the management of bowel stricture recurrence in patients who undergo surgery for Crohn's disease. The findings should provide much-needed guidance to surgeons and gastroenterologists battling this tough-to-manage intestinal disorder.
Published in the journal Surgery, the study is the brainchild of Dr. Fabrizio Michelassi, chairman of the Department of Surgery and the Lewis Atterbury Stimson Professor of Surgery at Weill Cornell Medical College, and surgeon-in-chief at NewYork-Presbyterian Hospital/Weill Cornell Medical Center in New York City.
"These findings offer surgeons working with Crohn's patients a degree of clarity that just wasn't there before, and should greatly enhance the surgical management of this disease," says Dr. Michelassi, a world-renowned authority in surgical management of Crohn's.
Among other findings, the study supports the notion that strictureplasty -- a bowel-sparing surgical procedure commonly used to correct Crohn's-related strictures -- is less likely to lead to stricture recurrence later on, compared to surgical excision ("resection") of the stricture.
Crohn's disease involves a chronic inflammation of the digestive tract, often resulting in pain and diarrhea. Disease onset typically occurs in young adulthood, and the disorder is characterized by strictures -- narrowings of the bowel -- which often require surgical excision or correction. There is currently no cure for Crohn's, which affects about seven in every 100,000 Americans.
In decades past, Crohn's patients typically underwent surgical removal of the bowel at the point of stricture, although in recent years, corrective, bowel-sparing "strictureplasties" have become much more common. Dr. Michelassi has been a pioneer in developing new strictureplasty techniques. But he says that, up till now, surgeons lacked good information on the long-term consequences of these operations compared with resection.
Seeking to change all that, Dr. Michelassi launched his own prospective, longitudinal study more than 20 years ago.
"Beginning with my work as a young surgeon at the University of Chicago, I kept records from the very first patient I operated on with Crohn's disease in 1988. By 2001, I had already operated on more than a thousand patients," he explains. During each procedure, Dr. Michelassi took pictures and made detailed sketches of those areas subject to surgery. "So, if these patients came to me again 5 or 10 years later with a stricture recurrence, I could compare the location of the recurrence to the site of the original surgery," he says.
Surgeons know that about one-third of patients who undergo Crohn's-related surgery will have a recurrence. However, since most Crohn's patients are young and prone to moving from city to city, only a long-term study at a major center could track enough patients to get a good picture of post-op trends over time. During his nearly 20 years at the University of Chicago (1984-2004), Dr. Michelassi was able to keep records on 981 patients who underwent a total of 1,132 procedures, 668 of which involved recurrent disease.
The study yielded some interesting findings.