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Background

Despite modern advances in the medical management of Crohn's disease (CD) up to 75% of patients will eventually require surgical intervention in their lifetime. Surgery for CD is not curative and recurrence rates between 30-60% have been reported after resection. A recently presented new anastomotic technique, the Kono-S (a side-to-side antimesenteric anastomosis), has been associated with a lower median anastomotic score (Rutgeert's 2.6 vs. 3.4) at 5 years and a significantly lower probability of reoperation, but this has not been adequately studied elsewhere yet. We describe our experience with this novel technique.

Methods

We created a prospective database of all patients undergoing resection for CD who had a Kono-S anastomosis. Postoperative endoscopic surveillance was performed at 3 to 12 months and endoscopic grade of recurrence were documented. We also recorded additional operative outcomes and complications.

Results

We performed 46 Kono-S anastomoses, 39 ileocolonic, 5 small bowel and 2 large bowel anastomoses in 44 patients (23 women), mean age 33.5 years (17-58 years). Twenty one patients (49%) had prior resection and were being operated on for recurrent disease and 12 patients (28%) had a prior or current history of smoking. Disease confined to the small bowel disease was present in 13 patients (30%), while the remainder had disease involving multiple segments. While all the anastomoses were handsewn extracorporeally in two layers, 21 procedures utilized laparoscopic mobilization (48%). Three patients required conversion from laparoscopy (14%). One patient (2.3%) had a contained anastomotic leak diagnosed by CT scan and was treated conservatively without further complications.

During the study period 17 patients (39%) underwent follow up endoscopic surveillance at our institution. One patient's prep was not sufficient to visualize the anastomosis and one patient had a large bowel anastomosis. The average Rutgeert's score reported for ileocolic anastomoses was 0.6 at a mean of 6.4 months. There was only one patient with a score of 2.

Discussion

We have demonstrated the safety and short-term efficacy of the Kono-S anastomosis in this single center experience. We plan longer term assessment and future comparative studies to better understand the unique mechanism of protection that may be conferred by this surgical approach.

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Copyright © 2011 Crohn's & Colitis Foundation of America, Inc.
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