Have you been experiencing stomach pain and discomfort for days? Your doctor may have told you that you have an inflammatory bowel disease (IBD) like Crohn's disease. When you have this condition for a long time, some areas inside your intestines gradually start to narrow. It's like a water pipe getting stuck in the middle. So, we call this special surgery to widen these narrowed areas `Strictureplasty`. Today, we will talk about everything in simple terms.
What exactly is Strictureplasty?
Simply put, a strictureplasty is a surgical procedure that widens a narrowed or blocked area in your intestine (called a stricture). This is usually caused by chronic inflammation, which is caused by inflammatory bowel diseases (IBD) such as Crohn's disease and Ulcerative Colitis. This inflammation causes scarring of the intestinal walls, which causes them to thicken and narrow.
These types of strictures most commonly occur in:
- The lower part of the small intestine (the ileum)
- Regarding the valve that connects the small intestine and the large intestine (the `ileocecal valve`).
However, this condition can also occur in the colon, rectum, and anus. The main goal of this surgery is to widen the narrowed part of the intestine and restore normal food movement, without removing any part of the intestine.
Why do you need this surgery?
When a part of your intestine becomes narrowed like this, food can't move down properly. This can cause a number of very uncomfortable and painful symptoms.
| Symptom | A simple explanation |
|---|---|
| Severe stomach pain and limping | This pain occurs because the intestines contract as they try to pass food through the blockage. |
| Stomach bloating and flatulence | The stomach swells because food and air cannot go down properly and get stuck in one place. |
| Nausea and vomiting | If the blockage is severe, food may not be able to go down and may come back up. |
| Constipation | Defecation becomes difficult due to the slow digestion process. |
| Loss of appetite and weight loss | Due to pain and discomfort, the desire to eat is lost, and the body is unable to absorb nutrients properly. |
| Fatigue and Anemia | Often, ulcers form in these narrowed areas. These ulcers bleed slowly, leading to anemia over time. This condition resolves after surgery. |
The most important thing: If this narrowing continues to increase, the intestine can become completely blocked (intestinal obstruction). This is a very dangerous and even life-threatening condition. Therefore, if you have symptoms, it is essential to see a doctor immediately.
Who is this surgery most suitable for and unsuitable for?
Strictureplasty surgery is not for everyone. Your doctor will make the best decision based on your situation.
| Those who are suitable for surgery | Cases when surgery is not recommended |
|---|---|
| If there are several narrowings in places along a long section of the intestine. | If there are several narrowings in a short section of the intestine, close together. |
| If you have previously undergone a bowel resection. | If there is an injury, inflammation, fistula, or abnormal growth at the narrowed area. |
| If you have short bowel syndrome. | The narrowing is near a previous surgical site (anastomosis). |
| If there is only narrowing, without inflammation or injury at the narrowed area. | If you have a perforated bowel. |
| If you have frequent symptoms of Crohn's disease. | If you are suffering from severe malnutrition. |
How do you prepare before surgery?
Because this is a planned surgery, your doctor will perform several tests beforehand.
- Imaging Tests: A test such as a CT scan or Magnetic Resonance Enterography (MRE) will be done to see exactly where the narrowings are in your intestines and how long they are.
- Blood Tests: Blood tests will be done to check your nutritional status. If you are malnourished, you may be given nutritional supplements through a vein (`IV`) for a few days before surgery. This will help you recover faster after surgery.
- Stoma (Ostomy bag): In some cases, after surgery, a temporary opening (`stoma`) may need to be made on the surface of the skin of the abdomen to allow stool to pass through, and a bag (`ostomy bag`) may need to be attached to it until the bowel heals. Don't worry about this. If this is necessary, your doctor will explain it to you thoroughly before the surgery.
How is the surgery done?
Strictureplasty is a major surgery performed under general anesthesia. You will need to stay in the hospital for a few days. Before the surgery begins, you will be given general anesthesia, so you will not feel any pain or have any memory of the surgery.
During the operation, the surgeon makes an incision along the narrowed part of the intestine and sews it open. Think of it as cutting a blocked tube lengthwise, separating the two ends of the incision, and stitching them together. When the intestine is wide, food can move through it more easily again. If you have multiple strictures, you can often treat all of them in one operation.
There are several types of Strictureplasty depending on the length of the narrowing:
Heineke-Mikulicz Strictureplasty
This is the most commonly used method. It is done for narrowings shorter than 10 centimeters (about 4 inches).
Finney or Jaboulay Strictureplasty
These are used for narrowings between 10-20 centimeters (about 8 inches) in length. In this surgery, the intestine is folded into a 'U' shape.
Michelassi Strictureplasty
This is a special procedure for strictures longer than 20 centimeters. In this procedure, the narrowed part of the intestine is folded in two, the two sides are brought together, a long incision is made, and the two are sewn together.
How long does it take to recover after surgery?
This is a major surgery, so it will take some time to recover. You may need to stay in the hospital for about a week . If there are complications, you may need to stay longer.
- Pain: You may experience some stomach pain in the first few days after surgery. The doctor will give you painkillers for this.
- Limitations: You will not be able to do things like lifting weights or driving for a few weeks.
- Watch out for infections: You should be very careful about developing an infection after surgery. If you have symptoms such as severe pain, fever, redness or swelling at the surgical site, or unusual discharge from the wound, you should inform your doctor immediately .
- Diet: Depending on your condition, your doctor or nutritionist may recommend a special diet (`GI soft diet`).
- IBD Treatment: The important thing to remember is that this surgery only widens the narrowing. It does not cure the underlying IBD (such as Crohn's). Therefore, you will need to continue taking other medications for your condition.
What is the difference between `Strictureplasty` and `Bowel Resection`?
This is a question that many people ask. There is a big difference between these two surgeries.
| Characteristic | Strictureplasty (widening) | Bowel Resection |
|---|---|---|
| What to do | The narrowed part of the intestine is widened . | The narrowed part of the intestine is cut out and the remaining two parts are joined. |
| Main advantage | The entire length of the intestine is preserved, reducing the risk of `Short Bowel Syndrome` (nutrition absorption problems) . | The risk of a problem occurring again in the same place may be slightly reduced. |
| Future risk | There is a high chance that surgery will be needed again in the future. | There is a low chance of needing re-surgery in the future. |
Doctors often try a strictureplasty first, because preserving the length of the intestine is very important for nutrition.
Take-Home Message
- Strictureplasty is a surgery to widen narrowed areas of the intestine due to diseases such as Crohn's. It does not involve cutting out parts of the intestine.
- This surgery can eliminate symptoms such as stomach pain and bloating, and reduce the dangerous risk of a complete blockage of the intestine.
- This surgery is not suitable for everyone. Your doctor will determine the most appropriate treatment based on your condition.
- This is a major surgery, so it takes time to heal. There are risks such as infection and bleeding.
- This surgery will only cure the narrowing. The underlying disease (IBD) must be treated.
- If you have any questions about this, don't be afraid to talk to your doctor and get everything cleared up.
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