Experiences with the Kono-S anastomosis in Crohn’s disease of the terminal ileum—a cohort study

Abstract

Purpose The most frequent long-term complication after ileocecal resection in Crohn’s disease is anastomotic recurrence and subsequent stenosis. Recurrence typically begins at the site of the anastomosis, raising the question of whether the surgical technique of the anastomosis could affect recurrence rates. Kono-S anastomosis is a hand-sewn antimesenteric functional end-to-end anastomosis that offers a wide lumen that is well accessible for endoscopic dilatation. The purpose of our study is to review the rate of postoperative complications almost 2 years after the introduction of this technique. Materials and methods This is a prospective single-center cohort study of all consecutive patients with Crohn’s disease undergoing ileocecal resection. Patients’ characteristics as well as specific data for the surgical procedure and short-term outcome were evaluated. Results Thirty patients were operated for Crohn’s disease of the terminal ileum (n = 24) or anastomotic recurrence (n = 6). Postoperative complications with a Clavien-Dindo Score ≥ IIIb were observed in three patients. One patient showed a hemorrhage and underwent surgical hemostasis. Two patients developed anastomotic leakage; in both cases, ileostomy was created after resection of the anastomosis. The median hospital stay was 9 days (IQR 7–12). A comparison with a historic group of conventionally operated patients of our hospital revealed no differences in short-term results except for the duration of surgery. Conclusion The Kono-S anastomosis is associated with acceptable short-term results, complications, and recurrence rates comparable with the established anastomotic techniques. Longer operation times are observed, but the few published studies concerning long-term recurrence are promising.

Kono-S Anastomosis in Crohn’s Disease: A Retrospective Study on Postoperative Morbidity and Disease Recurrence in Comparison to the Conventional Side-To-Side Anastomosis

“…Based on the results, our analysis supports the further evaluation of the Kono-S anastomosis technique following ICR in patients with Crohn’s disease in clinical routine in non-selective patient cohorts. In line with previous small studies focusing mainly on the perioperative morbidity of the Kono-S anastomosis [ 19 , 20 , 21 ], the rates of complications in our cohort were comparable between both groups, including the operating time and length of hospital stay ( Table 2 ). Furthermore, while our data demonstrated a clear trend towards decreased rates of disease recurrence, a multicenter study even demonstrated a five-year surgical recurrence-free survival rate of 98.6% in Japan [ 22 ].…”

Surgical Strategies to Reduce Postoperative Recurrence of Crohn's Disease After Ileocolic Resection

“…The 5 and 10-year cumulative surgical recurrence rate were both 1.7%, with surgical recurrence occurring in only two Japanese patients. Since then a number of case reports, case series and retrospective studies with comparison to historical patients undergoing traditional anastomotic techniques have been published and demonstrated encouraging results (78)(79)(80)(81)(82). A retrospective study by Shimada et al published in 2019 compared 117 patients who underwent Kono-S anastomosis to 98 patients who underwent HEEA (83).…”

Perioperative optimization of Crohn's disease

“…Then, 7‐cm long longitudinal enterotomies are created at the antimesenteric aspect, beginning 1 cm from the supporting column; the anastomoses of the bowels are then constructed transversely in a hand‐sewn fashion 111 . Several cohort studies and one randomized controlled trial have supported the use of this technique for reducing the postoperative recurrence rate 112–114 …”

“… 111 Several cohort studies and one randomized controlled trial have supported the use of this technique for reducing the postoperative recurrence rate. 112 , 113 , 114 …”