Heineke - Mikulicz Strictureplasty in Crohn's DiseaseVideo Type: CVideo
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Author: Iskander Bagautdinov
Specialties: General Surgery
Schools: Weill Cornell Medical College
Laparoscopic Heineke-Mikulicz strictureplasty in Crohn's disease of the small bowel
a. Duodenal, jejunal and neoterminal disease with single or multiple fibrotic strictures
b. Recurrences on previous small bowel and ileo-colonic anastomosis
a. Inflammatory masses
b. Generalized intra-abdominal sepsis
c. Long strictures with thick, unyielding intestinal wall
d. Dysplasia or carcinoma at the stricture site
e. Chronic bleeding from the diseased and strictured intestinal segment
Regular laparoscopic set-up
Complete assessment of disease extension with MR and/or CT enterography for the small bowel and colonoscopy for the colon
Anatomy and Landmarks
The entire small bowel must be Â¢runÂ¢ from the ligament of Treitz to the ileo-cecal valve to confirm the location of the diseased segment(s)
a. Bowel sparing
b. Quiescence of disease: Endoscopic, radiologic, and histopathologic evaluations after strictureplasty have highlighted complete CrohnÂ¢s regression at strictureplasty sites in several reports. The mechanism associated with such regression remains unknown.
c. Protection against recurrence: A large meta-analysis from 2007 reported that recurrence on a previous strictureplasty requiring surgical management occurred in only 10% of cases, which compares favorably to results obtained with small bowel resection. The mechanism associated with such protective effect remains unknown.
a. A large number of publications have highlighted the safety of strictureplasties for CrohnÂ¢s. A meta-analysis, including more than 3,000 strictureplasties has been published in 2007. Overall, mortality was nil and 13% of patients developed postoperative complications, including 4% septic complications (anastomotic leak, fistula, and abscess) and 3% postoperative hemorrhages.
b. Reports of small bowel adenocarcinoma developing at the site of strictureplasty have been documented. It is assumed that the risk of neoplastic transformation after strictureplasty is low and not sufficient to dissuade surgeons from performing those techniques.
Disclosure of Conflicts