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DISEASES OF THE COLON & RECTUM VOLUME 55: 6 (2012)
BACKGROUND: The Heineke-Mikulicz and Finney
techniques are conventional strictureplasties that have
been used to manage short (10 cm) and medium-
length (10 cm and 20 cm) strictures from Crohn’s
disease. Nonconventional strictureplasty techniques have
emerged to facilitate bowel conservation for atypical
strictures. These techniques include the modified Finney,
combined Heineke-Mikulicz and Finney, modified
Heineke-Mikuliczs, Michelassi, and modifications of it
and others.
OBJECTIVE: The aim of this study is to compare
conventional vs nonconventional strictureplasties with
respect to short-term complications and long-term
results.
DATA SOURCES AND STUDY SELECTION: A MEDLINE
search was performed using “Crohn’s disease,” “surgical
therapy,” “strictureplasty,” “complications,” “reoperation,”
and “recurrence” as medical subject headings. Studies
conducted between 1975 and June 31, 2010 were found
via PubMed, Ovid, Embase, and Cochrane databases
and categorized into 3 groups. These groups consist
of centers performing conventional strictureplasties,
nonconventional strictureplasties, or both. Studies with at
least 3 patients were reviewed.
INTERVENTIONS: A mixed-effects meta-analysis for each
outcome was performed by use of Supermix software by
SSI Scientific Software International.
MAIN OUTCOME MEASURES: We focused on immediate
and long-term complication rates among the groups.
The 6 immediate complications include small-bowel
obstructions, sepsis, other infections, reoperations, early
postoperative GI bleeds, and other early complications.
The 5 long-term complications include recurrent
strictures, small-bowel obstructions, reoperations,
carcinoma, and deaths.
RESULTS: We reviewed 32 studies with 1616 patients
who underwent 4538 strictureplasties. One thousand one
hundred fifty-seven patients underwent conventional
strictureplasties with an early complication rate
of 15%; 459 patients underwent nonconventional
strictureplasties with an early complication rate of 8%.
A late complication rate of 29% for the conventional
strictureplasty group and 17% for the nonconventional
strictureplasty group was noted.
LIMITATIONS: We are limited by the data published with
the inherent risk of finding and analyzing mostly articles
with positive results.
CONCLUSION: The nonconventional strictureplasty
techniques were noninferior to the conventional
Kelli Bullard Dunn, M.D., Section Editor
Comparison of Conventional and Nonconventional
Strictureplasties in Crohn’s Disease: A Systematic
Review and Meta-Analysis
Lorna Campbell, M.S.-I.V.
1
•RonaldAmbe,M.D.
2
•JamesWeaver,M.P.H.
3
Sue M. Marcus, Ph.D.
4
•BurtCagir,M.D.
5,6
Loyola University Stritch School of Medicine, Maywood, Illinois 1
Department of Surgery, Sacred Heart Hospital, Allentown, Pennsylvania 2
Research Foundation for Mental Health, Columbia University, New York State Psychiatric Institute, New York, New York 3
Departments of Psychiatry and Biostatistics, Columbia University, New York State Psychiatric Institute, Division of 4
Biostatistics, New York, New York
Robert Packer Hospital, Sayre, Pennsylvania 5
State University of New York, Upstate Medical University, Syracuse, New York 6
CURRENT STATUS
Financial disclosures: None reported.
Correspondence: Burt Cagir, M.D., Robert Packer Hospital, 1 Guthrie
Sq, Sayre, PA 18840. E-mail: cagir_burt@guthrie.org
Dis Colon Rectum 2012; 55: 714–726
DOI: 10.1097/DCR.0b013e31824f875a
©The ASCRS 2012