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Stricturoplasty is a surgical procedure performed to alleviate bowel narrowing due to scar tissue that has built up in the intestinal wall from an inflammatory condition such as Crohn disease. Three techniques are utilized depending on the length of the stricture. This activity reviews the step by step approach of the stricturoplasty procedure and highlights the role of the interprofessional team in the care of patients with Crohn disease after undergoing the procedure. Objectives: Identify the treatment considerations for patients with Crohn disease. Describe appropriate technique to be performed in Crohn disease stricturoplasty. Summarize the indications, contraindication, and complications for Crohn disease structuroplasty. Outline interprofessional team strategies for improving care coordination and communication in patients undergoing stricturoplasty and improve outcomes. Access free multiple choice questions on this topic.

Crohn disease is a chronic inflammatory bowel disease (IBD), first described by Crohn, Ginsberg, and Oppenheimer in 1932.[1] It usually presents as a transmural granulomatous inflammation affecting the gastrointestinal tract, most commonly the ileum, colon, or both.[2] The disease prevalence is on the rise with the highest incidence seen in North America, the United Kingdom, and northern Europe.[3] Patients usually present with chronic diarrhea, often accompanied by abdominal pain, weight loss, and blood or mucus in the stools.[4] Extraintestinal manifestations of IBD generally occur in 25 to 40%. Inflammatory manifestations can also occur outside of the gastrointestinal tract within the skin, eyes, liver, and joints.[5] Crohn disease is diagnosed clinically based on clinical signs and symptoms, imaging, including endoscopic with biopsy and tissue information in addition to laboratory results.[6] Intestinal complications of Crohn disease include obstruction and perforation of the small intestine or colon, abscesses, fistulas, intestinal bleeding, and strictures. Strictures are narrowed segments of intestine that usually result in bowel obstruction and can be debilitating in patients with Crohn disease.  Strictureplasty is a surgical procedure that relieves bowel narrowing secondary to scar tissue formation that usually accumulates in the intestinal wall from repeated inflammation and healing in Crohn disease. It is a safe and effective procedure that will preserve the bowel length and prevent metabolic complications associated with short gut syndrome in patients with symptomatic obstruction.

Complications of strictureplasty include:[15][16] Infection at the surgical incision Bleeding Bowel obstruction Anastomotic leak Additional strictures may form over time A systematic review and meta-analysis performed by Yamamoto et al. found that the overall complications of jejunal and/or ileal strictureplasties were 13% with septic complications occurring in only 4% of cases.[15]

Crohn disease is a relapsing inflammatory bowel disorder that is challenging to diagnose and manage. Management of Crohn disease should include a multidisciplinary team, including a physician assistant, nurse practitioner, hospitalists, gastroenterologist, surgeon, dietitian, ostomy nurse, and a pharmacist. Crohn can affect any organ in the body, and thus, appropriate specialists should be consulted early in the disease course. Nurse practitioners or physician assistants can follow the patient throughout the hospitalization and monitor the course of the disease. The pharmacist should educate the patient on different medications, their benefits, adverse effects, and the importance of compliance. Ostomy nurses will guide the patient on proper care of the ostomy bag. Nutritionists will provide diet recommendations to avoid symptoms exacerbation, disease flare-up, and possible readmissions. [Level 5]