Resection vs stricturotomy in terminal ileal CD
In terminal ileal CD, what are the differences in indications and outcomes between surgical resection and stricturotomy (side-to-side anastomosis)
What is known
- Resection produces a lower recurrence rate than strictureplasty; terminal ileal strictures often undergo ileocolic resection. 1
- Side-to-side enterocolic anastomosis is a nonresectional option for terminal ileitis; contraindications are abscess, fistula, or rigid/fibrotic stricture. 2
- Because terminal ileitis does not itself carry short-bowel-syndrome risk, nonresective surgery there is not primarily a bowel-length-preservation strategy but aims for morphologic/functional resolution of stenosis. 3
- Modified side-to-side isoperistaltic strictureplasty over the ileocecal valve (D'Hoore) is described for long (>20 cm) terminal ileal strictures as a bowel-sparing technique. 1
- A randomized trial compared laparoscopic ileocaecal resection versus infliximab for terminal ileitis; systematic review/meta-analysis compared strictureplasty vs resection for fibrostenotic Crohn's. 4,5
What is unknown / caveats
- Retrieved excerpts do not report head-to-head recurrence/leak percentages for resection vs stricturotomy at the terminal ileum
- Much bowel-sparing evidence is small cohorts, case reports, and technique descriptions
- The excerpts describe the direction of difference (resection = lower recurrence) but do not give quantitative outcome comparisons specific to the terminal ileum.
References
- Mohan HM, Coffey JC. Surgical treatment of intestinal stricture in inflammatory bowel disease. J Dig Dis. 2020;21(6):355-359. PMID: 32410340.
- Poggioli G, Stocchi L, Laureti S, Selleri S, Marra C, Magalotti C, Cavallari A. Conservative surgical management of terminal ileitis: side-to-side enterocolic anastomosis. Dis Colon Rectum. 1997;40(2):234-7; discussion 238-9. PMID: 9075763.
- [No authors listed]. Obstruction in Crohn's Disease: Strictureplasty Versus Resection. Curr Treat Options Gastroenterol. 2000;3(3):191-202. PMID: 11097736.
- Feinberg AE, Valente MA. Elective Abdominal Surgery for Inflammatory Bowel Disease. Surg Clin North Am. 2019;99(6):1123-1140. PMID: 31676052.
- Kellil T, Chaouch MA, Guedich A, Touir W, Dziri C, Zouari K. Surgical features to reduce anastomotic recurrence of Crohn's disease that requires reoperation: a systematic review. Surg Today. 2022;52(4):542-549. PMID: 34420112.
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⚠ Required context not in this corpus (moderate). Endoscopic balloon dilation is an established option for short (<5 cm) fibrostenotic and anastomotic Crohn's strictures, with high technical success and low complication rates (Bettenworth 2017 pooled analysis, PMID 28002130). It can defer or avoid repeat resection.
Why this matters: Presenting the choice as medical therapy versus repeat resection omits the bowel-sparing option that a suitable short stricture should be offered first.
Added by the landmark interlock. This corpus is surgical in scope and cannot admit the source paper (PMID 28002130). Not generated by the RAG.
Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct.
Reviewer notes