Finney and Jaboulay Strictureplasty



Finney and Jaboulay Strictureplasty


Pamela C. Sivathondan

Bruce D. George






PREOPERATIVE PLANNING

Once the decision to operate has been made, it is important to preoperatively optimize to reduce the risks of surgery:



  • Recent small bowel imaging and colonoscopy


  • Reduce risk factors: improve nutrition, reduce/stop steroids, eliminate/reduce sepsis


  • Multidisciplinary team discussion

For patients with small bowel stricturing disease, a period of clear fluid intake is needed for the 24-48 hours before surgery. Bowel preparation is not required unless there is distal colonic or rectal disease or the need for intraoperative colonoscopy is anticipated. Standard antibiotics and venous thromboprophylaxis should be given.


SURGERY


Initial Assessment

The initial phase of surgery involves careful assessment of the extent of stricturing disease. While most first operations may be laparoscopically undertaken, recurrent disease or cases of extensive small bowel stricturing may require laparotomy.

Most strictures may be detected by the presence of bowel wall thickening, mesenteric fat wrapping, or serosal neovascularization. Subtle strictures can be easily overlooked and balloon characterization of the whole small bowel from duodenum to cecum is recommended. The use of a calibrated Foley catheter inserted via a suitable enterotomy (at a site of planned resection or strictureplasty (SP)) is recommended (Fig. 69-1A and 1B). The length of the small bowel should be measured.






FIGURE 69-1 A. Balloon characterization of the small bowel. B. Calibrated balloon in the lumen of the small bowel.

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May 5, 2019 | Posted by in GENERAL | Comments Off on Finney and Jaboulay Strictureplasty
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