Kono-S anastomosis for Crohn’s disease: a systemic review, meta-analysis, and meta-regression

Ng, Cheng Han; Chin, Yip Han; Lin, Snow Yunni; Koh, Jeffery Wei Heng; Lieske, Bettina; Koh, Frederick; Chong, Choon Seng; Foo, Fung Joon

doi:10.1007/s00595-020-02130-3

Cited by 44 publications

(28 citation statements)

References 35 publications

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“…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: 82%

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

et al. 2021

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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.

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Section: Kono-s Anastomosismentioning

confidence: 82%

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

et al. 2021

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“…Importantly, while endoscopic recurrence rates were comparable between both groups, additive postoperative application of infliximab significantly decreased the number of surgical recurrences in patients with conventional anastomoses [64]. In addition, a recent meta-analysis revealed a strongly decreased mean Rutgeert score and an endoscopic recurrence of only 5% while rates of overall complications were rare [65]. The first randomized-controlled trial (SuPREMe-CD study) compared Kono-S anastomosis versus a conventional latero-lateral anastomosis and confirmed the significant reduction in postoperative endoscopic and clinical recurrence after a followup of 24 months [66].…”

Section: Improved Surgical Technique May Further Support the Beneficial Effects Of Surgery To Maintain Remission In CDmentioning

confidence: 95%

The Revival of Surgery in Crohn’s Disease—Early Intestinal Resection as a Reasonable Alternative in Localized Ileitis

et al. 2021

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Crohn’s disease (CD) represents a heterogeneous and complex disease with no curative therapeutic option available to date. Current therapy is mainly antibody-based focusing on the immune system while other treatment alternatives such as surgery are considered to be “last options”. However, medical therapy for CD results in mild to severe side effects in a relevant amount of patients and some patients do not respond to the medication. Following that, quality of life is often significantly reduced in this patient cohort, thus, therapeutic alternatives are urgently needed. Updated evidence has revealed that surgery such as ileocecal resection (ICR) might be a potential therapeutic option in case of localized terminal ileitis since resection at early time points improves quality of life and significantly reduces the postoperative need for immunosuppressive medication with low rates of morbidity. In addition, new surgical approaches such as Kono-S anastomosis or inclusion of the mesentery result in significantly reduced rates of disease recurrence and reoperation. Based on the new evidence, the goal of this review is to provide an update on the role of surgery as a reasonable alternative to medical therapy in the interdisciplinary treatment of patients with CD.

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“…In a previous randomized control trial (RCT), Kono‐S anastomosis, antimesenteric functional end‐to‐end handsewn anastomosis, were performed for the stenosis of the patients with CD, and the endoscopic recurrence was 22.2% in the Kono group and 62.8% in the conventional group (n = 79) 35 . In a previous meta‐analysis, the surgical outcomes of Kono‐S were found to be 0% for surgical recurrence and 5% for endoscopic recurrence 36 . Kono‐S anastomosis yields a favorable outcome with increasing evidence, hence may be considered an optimal procedure for CD stenosis.…”

Section: Ibdmentioning

confidence: 99%

“… 35 In a previous meta‐analysis, the surgical outcomes of Kono‐S were found to be 0% for surgical recurrence and 5% for endoscopic recurrence. 36 Kono‐S anastomosis yields a favorable outcome with increasing evidence, hence may be considered an optimal procedure for CD stenosis.…”

Section: Ibdmentioning

confidence: 99%

Essential updates 2020/2021: Colorectal diseases (benign)—Current topics in the surgical and medical treatment of benign colorectal diseases

Shinmoto

Miyamoto

Yoshida

et al. 2022

Annals of Gastroent Surgery

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The development of new drugs for inflammatory bowel disease (IBD) is remarkable, and treatment strategies using multiple agents and various techniques are required; however, the treatment strategy is likely to be complex. Therefore, appropriate evaluation of traditional surgical treatment strategies and accurate knowledge of the efficacy and limitations of novel treatments are required. Total infectious complications were found to be associated with the use of corticosteroids and anti‐tumor necrosis factor‐α agents, but not with immunomodulators, anti‐integrin agents, and 5‐aminosalicylic acid. Regarding surgical procedures for IBD, conceived anastomosis methods, including Kono‐S for Crohn's disease stenosis, are associated with better outcomes than conventional techniques. Autologous cell transplantation for Crohn's fistulae has been shown to have a favorable outcome. Diverticulitis is increasing and will be treated more frequently in the future. Risk factors for the incidence of diverticulitis and differences in pathogenesis according to right or left side diverticulitis have been reported. Antibiotic therapy may be omitted for uncomplicated diverticulitis. Moreover, regarding surgical procedures, both bowel resection and anastomosis are associated with favorable short‐term outcomes, higher stoma closure rate, and superior medical economy compared to Hartmann's procedure. Risk factors for recurrence after diverticulitis surgery may provide better postoperative follow‐up. In this review, we explore the current topics of colorectal benign diseases, focusing on IBD and diverticulitis, based on clinical trials and meta‐analyses from 2020‐2021. This review consolidates the available knowledge and improves the quality of surgical procedures and perioperative management for IBD and diverticulitis.

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Kono-S anastomosis for Crohn’s disease: a systemic review, meta-analysis, and meta-regression

Cited by 44 publications

References 35 publications

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

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

The Revival of Surgery in Crohn’s Disease—Early Intestinal Resection as a Reasonable Alternative in Localized Ileitis

Essential updates 2020/2021: Colorectal diseases (benign)—Current topics in the surgical and medical treatment of benign colorectal diseases

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