Diseases, Disorders information

For gastroduodenal Crohn’s disease, which is indeed quite rare, the symptoms of pain, nausea, vomiting and weight loss with studies to confirm upper GI Crohn’s disease with complications, as you see here, in obstruction, fistula and hemorrhage. The surgery for gastroduodenal Crohn’s disease is fortunately rare but consists really of only bypass and strictureplasty. Resection is reserved for only the worst situations.

What about disease-free margins in small-bowel Crohn’s disease? Just briefly, there are studies that show with normal and disease margins no difference in the rate of cumulative recurrence rate over an eight year period of time. This was published many years ago now, in 1983. In work from our own institution we would say that gross residual disease, in the orange line, has a much higher rate of recurrence than in the overall group of patients without gross residual disease. So what our practice is - at least mine is - is to approach the patient with small-bowel Crohn’s disease, resect that to non-diseased margins and do the anastomosis. If indeed the pathologist tells us that the margin is involved, I’ll go back slightly again - maybe 2 or 3 more centimeters - and do the anastomosis at that level. But I will not resect and resect apparently normal bowel if the disease margin is … if the margin is microscopically diseased only. Perhaps I can answer questions about that in a few minutes.

What about strictureplasty? I think all of you have surgeons who are interested in doing strictureplasty on patients. The rationale for strictureplasty, at least in their minds, is shown here. That indeed the disease involves the whole intestine. It is obviously impossible to cure Crohn’s disease by mere excision alone, and all diseased bowel does not need excision. So if the main problems the patients are having are stenotic in nature, then these can be relieved usually without excising the bowel. In this slide I will show you pretty much the originators or the popularizers of this operation. He was Alexander Williams in a 1985 publication showing a complication rate of about 14% and a symptom recurrence rate of 40% in patients who underwent strictureplasty. The Fazio group published a large group of patients, and our group here at the bottom showing the same preoperative complication rate and only 20% of the patients having recurrent symptoms. So strictureplasty is a definite option for patients with stenotic complications of small-bowel Crohn’s disease.