Conservative operations for Crohn's disease of the small bowel

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Abstract
Radical excision of the small bowel and affected lymph nodes was originally advocated for Crohn's disease of the small bowel. Subsequently, intestinal bypass became popular, either in continuity or by exclusion of the diseased segment. Bypass in turn was superseded by limited resection, which remains the procedure of choice in most patients. Recognition that Crohn's disease is both panintestinal in nature and incapable of surgical cure has led to increasingly conservative operations aimed solely at overcoming the complications of the disease. Balloon catheters have been used to assess luminal stenosis in 20 patients and to undertake dilatation of strictures between 20 and 25 mm in diameter. Tighter strictures have been treated by strictureplasty. In 3 years, 37 patients have had 43 operations and 106 strictureplasties. Rates for anastomotic leakage episodes of pain and fever and overt wound infection have all been below 10%. Six patients have required reoperation, usually for strictures elsewhere.