Heineke-Mikulicz, Finney, and Michelassi Strictureplasty



Heineke-Mikulicz, Finney, and Michelassi Strictureplasty


Heather Yeo

Fabrizio Michelassi





PREOPERATIVE PLANNING

Appropriate preoperative evaluation for patients with Crohn’s disease includes thorough assessment of extent of disease. Patients may present with a single symptomatic area of disease. Preoperative evaluation of the extent of disease aids in operative planning and in patient preparation in those circumstances when the disease is widespread and complex.

A computed tomography (CT) scan is often the initial imaging study performed to evaluate symptomatic Crohn’s disease. CT scan is useful in that it evaluates both intraluminal and extraluminal findings including obstruction, edema, abscess, and fistula. CT enterography or magnetic resonance enterography can provide greater detail on the intraluminal findings of mucosal disease. Endoscopic evaluation, including colonoscopy with ileal intubation, esophagogastroduodenoscopy, push-enteroscopy, and capsule endoscopy can help in assessing the disease. In patients with narrow strictures, a capsule endoscopy is contraindicated because the capsule could be retained proximal to a stenosis and cause obstruction.

Despite the increased accuracy of modern preoperative radiographic and endoscopic imaging, appropriate selection of operative procedures (strictureplasty, resection, bypass, or intestinal diversion)
can only be performed after careful intraoperative evaluation and creation of a “road map” at the time of the operative intervention. Therefore, preoperative discussions and informed consent should include all of the possible surgical options.


May 5, 2019 | Posted by in GENERAL | Comments Off on Heineke-Mikulicz, Finney, and Michelassi Strictureplasty
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