Original article Outcome of strictureplasty for duodenal Crohn's disease T. Yamamoto, I. M. Bain, A. B. Connolly, R. N. Allan* and M. R. B. Keighley University Department of Surgery and *Department of Gastroenterology, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK Correspondence to: Professor M. R. B. Keighley Background: The outcome of strictureplasty for duodenal Crohn's disease has not been critically documented. The aim of this study was to assess the outcome of strictureplasty for duodenal Crohn's disease. Methods: A retrospective review was undertaken of 13 patients who underwent strictureplasty including four pyloroplasties) for obstructive duodenal Crohn's disease between 1974 and 1997. Results: Ten patients underwent strictureplasty as the primary procedure, and in three strictureplasty was used as a revision procedure after previous bypass surgery. Two patients developed anastomotic breakdown and were treated either by Roux-en-Y duodenojejunostomy or partial gastrectomy. Symp- toms of obstruction persisted in four patients after strictureplasty; three eventually resolved after prolonged nasogastric aspiration, but the other required gastrojejunostomy. In the long term, six patients developed restricture at the previous strictureplasty site. Five required repeat strictureplasty and the other patient underwent duodenojejunostomy. One patient who had repeat strictureplasty required a further strictureplasty because of restricture at the previous strictureplasty site. Overall nine of 13 patients required further surgery because of early postoperative complications or restricture at the strictureplasty site. Conclusion: Strictureplasty for duodenal Crohn's disease is associated with a high incidence of post- operative complications and restricture. Paper accepted 2 October 1998 British Journal of Surgery 1999, 86, 259±262 Introduction Duodenal Crohn's disease is a rare condition. The frequency is reported to range between 0á 5 and 4á 0 per cent of cases of Crohn's disease 1±6 . For obstructive duodenal Crohn's disease, bypass procedures, particularly gastroje- junostomy, have been used widely 7±11 . Strictureplasty has become an acceptable surgical option in the management of short-segment Crohn's disease of the small bowel 12±16 . In the management of duodenal Crohn's disease, strictureplasty has the advantage of avoiding a blind loop syndrome, bile re¯ux gastritis, and the need for vagotomy or stomal ulceration 17 . The outcome of strictureplasty for duodenal Crohn's disease has not been documented fully, because the number of patients having strictureplasty in any single institution is small 17,18 . This study analysed the surgical outcome of patients with obstructive duodenal Crohn's disease to assess whether strictureplasty is associated with an improved outcome compared with conventional bypass surgery. Patients and methods Between 1974 and 1997, 23 patients underwent stricture- plasty or bypass surgery for obstructive duodenal Crohn's disease at the General Hospital or Queen Elizabeth Hospital, Birmingham. All operations were carried out by two consultant surgeons. Ten patients were initially treated by strictureplasty four at the pylorus), and 13 initially underwent bypass surgery: gastrojejunostomy, 11; duodenojejunostomy, one; and Roux-en-Y duodenojejunostomy, one. Three of 11 patients who initially underwent gastrojejunostomy required strictureplasty as a revision procedure. This study compared the outcome of strictureplasty and bypass surgery for obstructive duodenal Crohn's disease. Results Patient characteristics, operative details and surgical out- come are shown in Table 1. Many of the patients were Ó 1999 Blackwell Science Ltd British Journal of Surgery 1999, 86, 259±262 259