Our Summary

This research paper discusses the surgical treatment of strictures, which are abnormal narrowings in the bowel, that are caused by inflammatory bowel disease. When the bowel becomes inflamed, this can lead to changes in the bowel wall, such as the build-up of fibroblasts (a type of cell that produces collagen and other fibres) and collagen, which can cause strictures.

The paper explains that it can be difficult to determine whether a stricture is primarily caused by inflammation or by fibrosis (the thickening and scarring of connective tissue), as they require different treatments. Inflammatory strictures can often be treated with medication, whereas fibrotic strictures typically require surgery.

The paper describes two surgical approaches: endoluminal (inside the bowel) and extraluminal (outside the bowel). Endoscopic dilatation, a procedure that stretches the stricture, is suitable for small, isolated strictures. Other options include dividing the stricture while preserving the length of the bowel, or removing the section of the bowel that is affected by the stricture.

The paper also highlights the role of the mesentery (a fold of tissue that attaches the intestines to the wall of the abdomen) in stricture recurrence. In diseases like Crohn’s disease, which can involve periods of illness followed by periods of remission, it’s important to preserve as much of the bowel as possible, while also reducing the risk of the stricture recurring.

The paper concludes by emphasizing the importance of a multidisciplinary team approach, both before and after surgery, to improve patient outcomes in these complex cases.

FAQs

  1. What is the primary cause of strictures in inflammatory bowel disease?
  2. What are the surgical treatment options for fibrotic strictures in inflammatory bowel disease?
  3. How does the preservation of intestinal length factor into the surgical treatment of strictures in Crohn’s disease?

Doctor’s Tip

A helpful tip a doctor might tell a patient about bowel resection is to follow a healthy diet rich in fiber to promote regular bowel movements and prevent constipation. It is also important to stay hydrated and avoid foods that may cause discomfort or worsen symptoms. Additionally, it is important to follow your doctor’s recommendations for post-operative care, including taking prescribed medications and attending follow-up appointments. Regular exercise can also help promote bowel health and overall well-being.

Suitable For

Patients with inflammatory bowel disease, such as Crohn’s disease, are typically recommended bowel resection when they have strictures that are predominantly fibrotic and unresponsive to medication. Endoscopic dilatation may be suitable for short-segment isolated small bowel strictures, while surgical options include dividing the stricture but preserving length, performing a strictureplasty, or resecting the strictured segment. The preservation of intestinal length is important in preventing recurrence, and the involvement of a multidisciplinary team both pre- and postoperatively is essential for optimal outcomes.

Timeline

Before bowel resection:

  • Patient experiences symptoms of inflammatory bowel disease, such as abdominal pain, diarrhea, and weight loss.
  • Imaging studies, such as CT scans or MRI, may show strictures in the bowel wall.
  • Medications may be tried to reduce inflammation and symptoms, but if a stricture is causing obstruction or symptoms are not improving, surgery may be recommended.

After bowel resection:

  • Patient undergoes surgery to remove the strictured segment of the bowel.
  • Recovery period in the hospital includes monitoring for complications such as infection or bowel leakage.
  • Patients may need a temporary or permanent ostomy (opening on the abdomen for waste removal) depending on the extent of bowel removed.
  • Postoperative care involves monitoring for recurrence of strictures, adjusting medications to prevent inflammation, and dietary changes to promote healing and prevent complications.
  • Follow-up appointments with a multidisciplinary team, including gastroenterologists, surgeons, and dietitians, are important for long-term management and monitoring.

What to Ask Your Doctor

  1. What is the reason for the bowel resection and why is it necessary?
  2. What are the potential risks and complications of the surgery?
  3. What is the expected recovery time and rehabilitation process after the surgery?
  4. Will I need a temporary or permanent ostomy after the bowel resection?
  5. How will the surgery affect my bowel function and digestion?
  6. What are the long-term implications of having a bowel resection?
  7. Will I need any additional treatments or medications after the surgery?
  8. How often will I need follow-up appointments and monitoring after the surgery?
  9. Are there any dietary or lifestyle changes I should make post-surgery to support healing and prevent complications?
  10. What is the success rate of bowel resection surgery for treating bowel strictures in inflammatory bowel disease?

Reference

Authors: Mohan HM, Coffey JC. Journal: J Dig Dis. 2020 Jun;21(6):355-359. doi: 10.1111/1751-2980.12880. Epub 2020 Jun 18. PMID: 32410340