A new antimesenteric functional end-to-end handsewn anastomosis: Surgical prevention of anastomotic Recurrence in Crohn's disease

Toru Kono, Toshifumi Ashida, Yoshiaki Ebisawa, Naoyuki Chisato, Kotaro Okamoto, Hidetoshi Katsuno, Kotaro Maeda, Mikihiro Fujiya, Yutaka Kohgo, Hiroyuki Furukawa

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Abstract

BACKGROUND: Recurrence of Crohn's disease usually occurs at anastomotic sites. OBJECTIVE: A new anastomosis technique (Kono-S anastomosis) designed to minimize anastomotic restenosis was compared with conventional anastomoses. DESIGN AND SETTINGS: The Kono-S anastomosis technique was first used for Crohn's disease in 2003 at the Asahikawa Medical University Hospital. The resection is accomplished by transecting the bowel with a linear cutter so that the mesentery side is located in the center of the stump. Both stumps are sutured to create a supporting column to maintain the diameter and dimension of the anastomosis. Longitudinal enterotomies are made at the antimesenteric sides of the 2 segments of intestine. The side-to-side antimesenteric anastomosis is then performed in transverse fashion. The medical records and follow-up details of all patients undergoing this procedure were reviewed. PATIENTS: From 2003 to 2009, 69 patients with Crohn's disease who underwent Kono-S anastomosis (group S) were compared with 73 historical patients with Crohn's disease who underwent conventional anastomosis (group C) from 1993 to 2003. MAIN OUTCOME MEASURES: A Kaplan-Meier analysis of the follow-up data on surgical recurrence at the anastomosis was performed. The endoscopic recurrence score at the anastomosis was calculated. RESULTS: The median endoscopic recurrence score in group S was significantly lower than that in group C (2.6 vs 3.4; P =.008). The Kaplan-Meier analysis showed a lesser probability of anastomotic surgical recurrence in the S group at 5 years (0% vs 15%; P =.0013). The absence of postoperative infliximab did not affect the restenosis rate in group S. LIMITATIONS: This study was limited by its historical retrospective nature. CONCLUSION: The Kono-S anastomosis appears to be effective in preventing anastomotic surgical recurrence in Crohn's disease.

Original languageEnglish
Pages (from-to)586-592
Number of pages7
JournalDiseases of the Colon and Rectum
Volume54
Issue number5
DOIs
Publication statusPublished - 01-05-2011

All Science Journal Classification (ASJC) codes

  • Gastroenterology

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    Kono, T., Ashida, T., Ebisawa, Y., Chisato, N., Okamoto, K., Katsuno, H., Maeda, K., Fujiya, M., Kohgo, Y., & Furukawa, H. (2011). A new antimesenteric functional end-to-end handsewn anastomosis: Surgical prevention of anastomotic Recurrence in Crohn's disease. Diseases of the Colon and Rectum, 54(5), 586-592. https://doi.org/10.1007/DCR.0b013e318208b90f