Kono-S anastomosis after intestinal resection for Crohn’s disease

Peltrini, Roberto; Greco, Paola Antonella; Manfreda, Andrea; Luglio, Gaetano; Bucci, Luigi

doi:10.1007/s13304-019-00700-w

Cited by 30 publications

(14 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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 ].…”

Section: Discussionsupporting

confidence: 89%

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

Kelm

Reibetanz

Kim³

et al. 2022

JCM

View full text Add to dashboard Cite

Introduction: The rates of postoperative recurrence following ileocecal resection due to Crohn’s disease remain highly relevant. Despite this fact, while the Kono-S anastomosis technique initially demonstrated promising results, robust evidence is still lacking. This study aimed to analyze the short- and long-term outcomes of the Kono-S versus side-to-side anastomosis. Methods: A retrospective single-center study was performed including all patients who received an ileocecal resection between 1 January 2019 and 31 December 2021 at the Department of Surgery at the University Hospital of Wuerzburg. Patients who underwent conventional a side-to-side anastomosis were compared to those who received a Kono-S anastomosis. The short- and long-term outcomes were analyzed for all patients. Results: Here, 29 patients who underwent a conventional side-to-side anastomosis and 22 patients who underwent a Kono-S anastomosis were included. No differences were observed regarding short-term postoperative outcomes. The disease recurrence rate postoperatively was numerically lower following the Kono-S anastomosis (median Rutgeert score of 1.7 versus 2.5), with a relevantly increased rate of patients in remission (17.2% versus 31.8%); however, neither of these results reached statistical significance. Conclusion: The Kono-S anastomosis method is safe and feasible and potentially decreases the severity of postoperative disease remission.

show abstract

Section: Discussionsupporting

confidence: 89%

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

Kelm

Reibetanz

Kim³

et al. 2022

JCM

View full text Add to dashboard Cite

show abstract

“…In summary this trial demonstrated that the Kono-S anastomosis was associated with lower rates of endoscopic and clinical recurrence with a similar safety profile to SSSA. A number of systematic reviews and meta-analyses have been published and appear to confirm the lower anastomotic leak rates and lower rates of endoscopic and surgical recurrence reported in the individual studies (85)(86)(87). There is an ongoing prospective multicentre randomised controlled trial (NCT03256240) comparing the Kono-S anastomosis to SSSA, this will hopefully give more definitive answers on the impact of the Kono-S anastomosis on the natural history of CD after ileocolic resection.…”

Section: Kono-s Anastomosismentioning

confidence: 83%

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

et al. 2021

View full text Add to dashboard Cite

Postoperative recurrence after ileocaecal resection for fibrostenotic terminal ileal Crohn's disease is a significant issue for patients as it can result in symptom recurrence and requirement for further surgery. There are very few modifiable factors, aside from smoking cessation, that can reduce the risk of postoperative recurrence. Until relatively recently, the surgical technique used for resection and anastomosis had little or no impact on postoperative recurrence rates. Novel surgical techniques such as the Kono-S anastomosis and extended mesenteric excision have shown promise as ways to reduce postoperative recurrence rates. This manuscript will review and discuss the evidence regarding a range of surgical techniques and their potential role in reducing disease recurrence. Some of the techniques have been shown to be associated with significant benefits for patients and have already been integrated into the routine clinical practice of some surgeons, while other techniques remain under investigation. Current techniques such as resection of the mesentery close to the intestine and stapled side to side anastomosis are being challenged. It is looking more likely that surgeons will have a major role to play when it comes to reducing recurrence rates for patients undergoing ileocaecal resection for Crohn's disease.

show abstract

“…Firm recommendations as to whether the Kono-S anastomosis should become the technique of choice following ileocolic resection for CD would currently be premature, although the first recently published randomized control trial supports its use in such a context [ 27 ]. The few published reports, including ours, highlight the potential advantages of this new technique but also underline the need for further research and evidence [ 36 ].…”

Section: Discussionmentioning

confidence: 96%

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

Horisberger

Birrer

Rickenbacher

et al. 2020

Langenbecks Arch Surg

View full text Add to dashboard Cite

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.

show abstract

Kono-S anastomosis after intestinal resection for Crohn’s disease

Cited by 30 publications

References 40 publications

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

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

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

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

Contact Info

Product

Resources

About