Abstract
PurposeThe 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 methodsThis 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.ResultsThirty 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.ConclusionThe 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.
Highlights
Medical therapy has profoundly improved the course of Crohn’s disease (CD) and reduced the need for surgical interventions
Kono-S anastomosis led to fewer short-term complications as well as improved long-term results with respect to anastomotic patency
From April 2018 to October 2019, 30 patients were eligible for a reconstruction after ileocecal resection with a Kono-S anastomosis
Summary
Medical therapy has profoundly improved the course of Crohn’s disease (CD) and reduced the need for surgical interventions. 50% of patients develop a recurrence, and reoperation rates gradually increase over time [8, 9]. This increase raises the question of whether alterations in the surgical technique may lead to lower reoperation rates. There have been few comparative cohort studies with side-to-end and end-to-end anastomoses [14, 15]. In both comparisons, Kono-S anastomosis led to fewer short-term complications as well as improved long-term results with respect to anastomotic patency
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