Strictureplasty
What the Examiner Expects
A bowel-preserving technique that widens a fibrotic stricture without resecting bowel, primarily used in Crohn's disease to prevent short bowel syndrome. The Heineke-Mikulicz technique (for strictures < 10 cm) involves a longitudinal enterotomy over the stricture closed transversely — identical in principle to a pyloroplasty. The Finney technique is used for longer strictures (10–20 cm). The Michelassi side-to-side isoperistaltic strictureplasty can address very long strictured segments. The examiner expects you to know that strictureplasty is contraindicated if there is active sepsis, perforation, fistula, phlegmon, or suspicion for malignancy at the stricture site.
Key Examiner Focus Points
- Bowel-preserving technique for fibrotic Crohn's strictures
- Heineke-Mikulicz for short strictures (< 10 cm), Finney for intermediate (10–20 cm)
- Contraindicated if stricture harbors malignancy, perforation, or phlegmon
- Can perform multiple strictureplasties in the same operation
- Do NOT perform on colonic strictures in Crohn's (higher malignancy risk)
Common Curveballs
Frozen section of the stricture shows dysplasia
Convert to resection. Dysplasia or malignancy at the stricture site is a contraindication to strictureplasty. Resect the segment with adequate margins.
Patient has 8 strictures throughout the jejunum and ileum
Multiple strictureplasties can be performed in the same operation — this is actually the main advantage of the technique. Combine with resection only for segments with associated phlegmon, fistula, or abscess.
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