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, Matthias; Reibetanz, J.; Kim, Mia; Schoettker, Kathrin; Brand, Markus; Meining, Alexander; Germer, Christoph‐Thomas; Flemming, Sven

doi:10.3390/jcm11236915

Cited by 11 publications

(13 citation statements)

References 31 publications

(37 reference statements)

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“…The literature's quality was evaluated concerning selection bias, comparability bias, and result evaluation bias according to the NOS scale. A research quality score of 9 was achieved by one paper[ 15 ], while three papers[ 19 , 20 , 22 ] received a research quality score of 8. Additionally, one paper[ 21 ] secured a research quality score of 7.…”

Section: Resultsmentioning

confidence: 99%

Impact of different anastomosis methods on post-recurrence after intestinal resection for Crohn's disease: A meta-analysis

Wang,

Zhao,

Shen

et al. 2024

World J Gastrointest Surg

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BACKGROUND Crohn's disease (CD) is a chronic inflammatory disease of the gastrointestinal tract, often requiring intestinal resection as a common treatment. However, recurrence after surgery is common. The anastomotic configuration after bowel resection appears to be associated with the recurrence of CD. Previous studies have suggested that the Kono-S anastomosis may help to reduce the recurrence rate. However, the results remain controversial. Therefore, evidence-based evidence is needed to prove the advantages of Kono-S anastomosis. AIM To measure the influence of anastomosis techniques on the long-term relapse rate of CD by conducting a meta-analysis. METHODS PubMed, Scopus, and Cochrane Library were searched until October 8, 2023. Patients who underwent intestinal resection due to CD were included. The intervention measures included Kono-S anastomosis, whereas the control group received traditional anastomosis such as end-to-end, end-to-side, and side-to-side anastomosis. Only randomized clinical trials and observational studies were included. The primary outcome measures were hospital stay post-surgery, overall postoperative complication incidence, the proportion of Clavien-Dindo grade IIIa or higher, overall postoperative recurrence rate, and Rutgeerts score. RESULTS From 2011 to 2023, six articles met the inclusion and exclusion criteria. The results indicated that Kono-S anastomosis can reduce the hospital stay post-surgery of patients with CD [MD = -0.26, 95%CI: -0.42 to -0.10, P = 0.002] than other traditional anastomosis methods. Compared to other traditional anastomosis methods, Kono-S anastomosis can significantly reduce the total recurrence rate [MD = 0.40, 95%CI: 0.17 to 0.98, P = 0.05] and postoperative Rutgeerts score [MD = -0.81, 95%CI: -0.96 to -0.66, P < 0.001] in patients with CD. However, there is no significant disparity in the overall occurrence of postoperative complications and the proportion of Clavien-Dindo ≥ IIIa. CONCLUSION Kono-S anastomosis has the potential to expedite the recuperation of CD and diminish relapse hazards; however, additional larger trials are necessary to authenticate its effectiveness.

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Section: Resultsmentioning

confidence: 99%

Impact of different anastomosis methods on post-recurrence after intestinal resection for Crohn's disease: A meta-analysis

Wang,

Zhao,

Shen

et al. 2024

World J Gastrointest Surg

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“…In Crohn’s disease, postoperative disease recurrence at the site of the anastomosis following ileocecal resection remains a major challenge for all disciplines resulting in a significant burden for many patients. Despite relevant advances of surgical techniques, real world data demonstrate high rates of recurrent inflammation at the site of the anastomosis during follow-up 26 . An important aspect to improve postoperative outcome and to decrease rates of disease recurrence is the role of inflamed resection margins.…”

Section: Discussionmentioning

confidence: 99%

Positive resection margins in Crohn’s disease are a relevant risk factor for postoperative disease recurrence

Kelm,

Benatzky,

Buck

et al. 2024

Sci Rep

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Postoperative disease recurrence in Crohn’s disease represents a relevant issue despite recent advancements in surgical and medical therapies. Additional criteria are necessary to improve the identification of patients at risk and to enable selective therapeutic approaches. The role of resection margins on disease recurrence remains unclear and general recommendations are lacking. A single-center retrospective analysis was performed including all patients who received ileocecal resection due to Crohn’s disease. Resection margins were analyzed by two independent pathologists and defined by histopathological criteria based on previous consensus reports. 158 patients were included for analysis with a median follow up of 35 months. While postoperative morbidity was not affected, positive resection margins resulted in significantly increased rates of severe endoscopic recurrence at 6 months (2.0% versus 15.6%, p = 0.02) and overall (4.2% versus 19.6%, p = 0.001), which resulted in significantly increased numbers of surgical recurrence (0% versus 4.5%, p = 0.04). Additionally, positive margins were identified as independent risk factor for severe endoscopic disease recurrence in a multivariate analysis. Based on that, positive margins represent an independent risk factor for postoperative endoscopic and surgical disease recurrence. Prospective studies are required to determine whether extended resection or postoperative medical prophylaxis is beneficial for patients with positive resection margins.

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“…More specifically, a meta-analysis by Ng et al [12] estimated a significantly lower risk (1%) of anastomotic leak when Kono-S was performed. Similarly, Shimada et al [6] reported that Kono-S resulted in a significant reduction in anastomotic leakage rates, while Kelm et al [18] associated the new approach with a higher risk of surgical site infections. In addition to these, recently published comparative studies [17,19] provided contradictive results regarding the comparability of Kono-S and conventional anastomotic techniques in terms of postoperative complications.…”

Section: Introduction 1rationalementioning

confidence: 96%

“…The initial report by Kono et al [15] suggested a significantly lower endoscopic recurrence score at 5 years postoperative, with no increase in postoperative morbidity. Subsequent trials, though, failed to confirm this superiority of Kono-S over conventional anastomoses [16,18,19]. On the contrary, a recent pooled analysis [20] reported a 24.7% incidence of endoscopic recurrence in the Kono-S arm, compared to the respective 42.6% in the comparison group.…”

Section: Introduction 1rationalementioning

confidence: 99%

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The Reduction of Anastomosis-Related Morbidity Using the Kono-S Anastomosis in Patients with Crohn’s Disease: A Meta-Analysis

Baloyiannis,

Perivoliotis,

Sarakatsianou

et al. 2024

JCM

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(1) Background: we conducted this study to evaluate the effect of Kono-S anastomosis on postoperative morbidity after bowel resection for Crohn’s disease. (2) Methods: This study adhered to the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. The primary endpoint was the overall complications rate. Secondary outcomes included specific complications analyses, disease recurrence and efficiency endpoints. A systematic literature screening was performed in major electronic scholar databases (Medline, Scopus, Web of Science), from inception to 17 January 2024. Both Random (RE) and Fixed Effects (FE) models were estimated; the reported analysis was based on the Cochran Q test results. (3) Results: Overall, eight studies and 913 patients were included in this meta-analysis. Pooled analyses confirmed that Kono-S was not superior in terms of overall morbidity (OR: 0.69 [0.42, 1.15], p = 0.16). Kono-S displayed a reduced risk for anastomotic leakage (OR: 0.34 [0.16, 0.71], p = 0.004) and reoperation (OR: 0.12 [0.05, 0.27], p < 0.001), and a shortened length of hospital stay (WMD: −0.54 [−0.73, −0.34], p < 0.001). On the contrary, Kono-S results in higher rates of postoperative SSIs (OR: 1.85 [1.02, 3.35], p = 0.04). (4) Conclusions: This study confirms a comparable morbidity, but a lower risk of anastomotic leak and reoperation of Kono-S over conventional anastomoses. Further high quality studies are required to validate these findings.

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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

Cited by 11 publications

References 31 publications

Impact of different anastomosis methods on post-recurrence after intestinal resection for Crohn's disease: A meta-analysis

Impact of different anastomosis methods on post-recurrence after intestinal resection for Crohn's disease: A meta-analysis

Positive resection margins in Crohn’s disease are a relevant risk factor for postoperative disease recurrence

The Reduction of Anastomosis-Related Morbidity Using the Kono-S Anastomosis in Patients with Crohn’s Disease: A Meta-Analysis

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