Medical Condition News

Thousands of Americans suffering from the chronic inflammatory bowel condition known as Crohn's disease are leading longer, healthier lives owing to innovative new surgeries, according to experts at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

"Four out of five Crohn's patients will require some kind of surgery at some point during their lives, but these improved, frequently minimally invasive techniques are sparing precious bowel tissue while improving quality of life," says senior author Dr. Fabrizio Michelassi, Lewis Atterbury Stimson Professor and chairman of the Department of Surgery at Weill Cornell Medical College and surgeon-in-chief at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

He and co-author Dr. Sharon L. Stein, assistant professor of surgery at Weill Cornell Medical College and colorectal surgeon at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, wrote a "state of the science" review in a recent issue of the journal Practical Gastroenterology .

As many as 500,000 people in the U.S. suffer from Crohn's disease, which triggers inflammation along the gastrointestinal tract, most commonly in the lower bowel. Certain drugs can help easiness symptoms, but there is no cure for this chronic sickness. Some of the more severe difficulties of Crohn's disease involve strictures (narrowing of the bowel), abscesses, perforations, fistulas (abnormal, obstructive connections between tissues), hemorrhage and even cancers. These types of difficulties frequently require surgical intervention.

"In the past, this was limited to complex, invasive surgeries that essential the removal of whole sections of the affected bowel. But over the past 2 decades, advances in surgery have changed that paradigm," Dr. Stein notes.

Some of the innovations outlined in the review include:

• Strictureplasty. This technique has revolutionized bowel surgery, the experts say. "In the past, surgeons would cut out whole sections of diseased bowel, shortening the organ and thus limiting gastrointestinal function," explains Dr. Michelassi, a world-renowned pioneer in the technique. With strictureplasty, surgeons leave the affected length of bowel in place but broaden it, "much like letting out the seams on a pant-leg," he says. This spares bowel tissue while "restructuring" it, so that intestinal contents can securely pass through.
• Fistula Plugs. Fistulas can be both painful and dangerous, causing intestinal contents to diverge from the anal canal. This frequently leads to anal incontinence, abscesses and, most soundly, systemic infection. Certain surgeries can drain the fistula tract but for more hard lesions a new surgical anal plug -- made from grafted porcine tissue -- is located over the fistula. The plug triggers the growth of local fibrotic tissue that then closes off the fistula tract. "In studies, this approach has proven successful in up to half of Crohn's patients," Dr. Stein says.
• Laparoscopic Surgery. "Patients -- specially younger patients -- prefer laparoscopic surgery owing to the little incision involved leaves small external scarring, even after repeat procedures," Dr. Michelassi notes. These minimally invasive techniques also lead to fewer surgery-linked inner tissue adhesions. Laparoscopic procedures do tend to require more training on the part of surgeons, and they can take longer to perform than conventional surgery. "However, they also lead to shorter hospital stays, saving money and getting patients home faster," Dr. Stein notes.

These and other surgical advances are giving patients useful new options against a relentless disease, Dr. Michelassi says.

"In our work here at NewYork-Presbyterian/Weill Cornell, we're learning that we can do so much more than we thought we could -- reducing surgical risks, sparing bowel and helping patients have better outcomes," he says.

Dr. Stein agrees. "As we learn more, and become more comfortable with these techniques, our success emboldens us to reach for the consequent generation of advances. Year by year, it's making a real difference in patients' lives."

http://www.med.cornell.edu/