Time for an Australian and New Zealand randomized controlled trial to study the modified <scp>Kono S</scp> anastomosis

Clark, David; Smith, N.; Clark, Imogen; Giddings, Hugh; Rajan, Ruben

doi:10.1111/ans.17991

Cited by 2 publications

(1 citation statement)

References 13 publications

(30 reference statements)

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“…However, the conventional U-shaped EEA anastomosis is not suitable for endoscopic observation or balloon dilation. As a result, the Kono-S anastomosis structure surpasses the traditional EEA anastomosis structure in facilitating postoperative follow-up and treatment of anastomotic problems[ 22 , 32 ].…”

Section: Discussionmentioning

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: Discussionmentioning

confidence: 99%