A New Antimesenteric Functional End-to-End Handsewn Anastomosis: Surgical Prevention of Anastomotic Recurrence in Crohn's Disease

Abstract

The Kono-S anastomosis appears to be effective in preventing anastomotic surgical recurrence in Crohn's disease.

Crohn’s Recurrence After Intestinal Resection and Anastomosis

“…Dr. Kono has named this new anastomosis an antimesenteric functional end-to-end hand-sewn anastomosis, or Kono-S anastomosis. Initial reports indicate that the endoscopic recurrence rate at 3 and 12 months after surgery is lower than after a side-toside functional end anastomosis [5]. These initial observations were confirmed by another prospective observational study [6].…”

Novel Antimesenteric Functional End-to-End Handsewn (Kono-S) Anastomoses for Crohn's Disease: A Report of Surgical Procedure and Short-Term Outcomes

“…A recent study conducted by Kono [6] showed the novel anastomotic technique (Kono-S anastomosis) focusing on rationale for the recurrence site, anastomotic susceptibility to mechanical distortions, and preservation of blood supply and innervation. It revealed that Kono-S anastomosis was superior to standard anastomoses such as, handsewn end-to-end or side-to-side anastomosis with a single layer of continuous absorbable sutures, or stapled functional end-to-end anastomosis concerning endoscopic recurrence score and surgical recurrence at 5 years.…”

“…The mesentery proper or mesocolon was divided at the mesenteric edge of the bowel wall using vessel-sealing system (Liga​Sure system, Valleylab, Boulder, CO) to avoid unnecessary devascularization and denervation of residual intestine [6] (fig. 1a).…”

“…Kono-S anastomosis was originally designed to avoid postoperative anastomotic restenosis in patients with Crohn's disease. The concept of the procedure was to create a large caliber robust functional end-to-end handsewn anastomosis with supporting column, preventing distortion and deformity at the anastomosis [6]. We report the concept of the procedure and short-term outcomes regarding postoperative complications, endoscopic recurrence score [4] at the anastomosis, and surgical recurrence rate.…”

Single‐incision laparoscopic subtotal colectomy through ileostomy site for ulcerative colitis – a video vignette

“…To date, no anastomotic technique has been proven to be superior in reducing surgical recurrence rates in this setting. In 2003 a new combined stapled and hand-sewn antimesenteric functional end-to-end anastomosis (Kono-S anastomosis) was designed to minimize surgical recurrence [2]. In this video report, we describe our technique for performance of a new antimesenteric functional end-to-end handsewn (Kono-S) anastomosis [3] (Video S1).…”