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Clin Colon Rectal Surg 2020; 33(06): 335-343
DOI: 10.1055/s-0040-1714236
Review Article

Surgical Treatment for Crohn's Disease: A Role of Kono-S Anastomosis in the West

Toru Kono
1   Advanced Surgery Center, Department of Surgery, Sapporo Higashi Tokushukai Hospital, Higahi-ku, Sapporo, Hokkaido, Japan
,
Alessandro Fichera
2   Division of Colon and Rectal Surgery, Baylor University Medical Center, Dallas, Texas
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Abstract

More than 80% of patients with Crohn's disease (CD) will require surgical intervention during their lifetime, with high rates of anastomotic recurrence and stenosis necessitating repeat surgery. Current data show that pharmacotherapy has not significantly improved the natural history of postoperative clinical and surgical recurrence of CD. In 2003, antimesenteric hand-sewn functional end-to-end (Kono-S) anastomosis was first performed in Japan. This technique has yielded very desirable outcomes in terms of reducing the incidence of anastomotic surgical recurrence. The most recent follow-up of these patients showed that very few had developed surgical recurrence. This new approach is superior to stapled functional end-to-end anastomosis because the stumps are sutured together to create a stabilizing structure (a “supporting column”), serving as a supportive backbone of the anastomosis to help prevent distortion of the anastomotic lumen due to disease recurrence and subsequent clinical symptoms. This technique requires careful mesenteric excision for optimal preservation of the blood supply and innervation. It also results in a very wide anastomotic lumen on the antimesenteric side. The Kono-S technique has shown efficacy in preventing surgical recurrence and the potential to become the new standard of care for intestinal CD.

Keywords

stapled functional end-to-end anastomosis - supporting column - surgical recurrence - Crohn’s disease


Publikationsverlauf

Artikel online veröffentlicht:
14. September 2020

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

  • References

  • 1 Baumgart DC, Sandborn WJ. Crohn's disease. Lancet 2012; 380 (9853): 1590-1605
    CrossrefPubMedGoogle Scholar
  • 2 Cosnes J, Nion-Larmurier I, Beaugerie L, Afchain P, Tiret E, Gendre JP. Impact of the increasing use of immunosuppressants in Crohn's disease on the need for intestinal surgery. Gut 2005; 54 (02) 237-241
    CrossrefPubMedGoogle Scholar
  • 3 Fichera A, Schlottmann F, Krane M, Bernier G, Lange E. Role of surgery in the management of Crohn's disease. Curr Probl Surg 2018; 55 (05) 162-187
    CrossrefPubMedGoogle Scholar
  • 4 Nos P, Domenech E. Postoperative Crohn's disease recurrence: a practical approach. World J Gastroenterol 2008; 14 (36) 5540-5548
    CrossrefPubMedGoogle Scholar
  • 5 Terdiman JP. Prevention of postoperative recurrence in Crohn's disease. Clin Gastroenterol Hepatol 2008; 6 (06) 616-620
    CrossrefPubMedGoogle Scholar
  • 6 Bakouny Z, Yared F, El Rassy E. et al. Comparative efficacy of anti-TNF therapies for the prevention of postoperative recurrence of Crohn's disease: a systematic review and network meta-analysis of prospective trials. J Clin Gastroenterol 2019; 53 (06) 409-417
    CrossrefPubMedGoogle Scholar
  • 7 Regueiro M, Strong SA, Ferrari L, Fichera A. Postoperative medical management of Crohn's disease: prevention and surveillance strategies. J Gastrointest Surg 2016; 20 (08) 1415-1420
    CrossrefPubMedGoogle Scholar
  • 8 Masaki T, Kishiki T, Kojima K, Asou N, Beniya A, Matsuoka H. Recent trends (2016-2017) in the treatment of inflammatory bowel disease. Ann Gastroenterol Surg 2018; 2 (04) 282-288
    CrossrefPubMedGoogle Scholar
  • 9 Yamamoto T, Watanabe T. Surgery for luminal Crohn's disease. World J Gastroenterol 2014; 20 (01) 78-90
    CrossrefPubMedGoogle Scholar
  • 10 Michelassi F. Crohn's recurrence after intestinal resection and anastomosis. Dig Dis Sci 2014; 59 (07) 1352-1353
    CrossrefPubMedGoogle Scholar
  • 11 Kono T, Ashida T, Ebisawa Y. et al. A new antimesenteric functional end-to-end handsewn anastomosis: surgical prevention of anastomotic recurrence in Crohn's disease. Dis Colon Rectum 2011; 54 (05) 586-592
    CrossrefPubMedGoogle Scholar
  • 12 Shimada N, Ohge H, Kono T. et al. Surgical recurrence at anastomotic site after bowel resection in Crohn's disease: comparison of Kono-S and end-to-end anastomosis. J Gastrointest Surg 2019; 23 (02) 312-319
    CrossrefPubMedGoogle Scholar
  • 13 Kono T, Fichera A, Maeda K. et al. Kono-S anastomosis for surgical prophylaxis of anastomotic recurrence in Crohn's disease: an International Multicenter Study. J Gastrointest Surg 2016; 20 (04) 783-790
    CrossrefPubMedGoogle Scholar
  • 14 Katsuno H, Maeda K, Hanai T, Masumori K, Koide Y, Kono T. Novel antimesenteric functional end-to-end handsewn (Kono-S) anastomoses for Crohn's disease: a report of surgical procedure and short-term outcomes. Dig Surg 2015; 32 (01) 39-44
    CrossrefPubMedGoogle Scholar
  • 15 Fichera A, Zoccali M, Kono T. Antimesenteric functional end-to-end handsewn (Kono-S) anastomosis. J Gastrointest Surg 2012; 16 (07) 1412-1416
    CrossrefPubMedGoogle Scholar
  • 16 Kono T, Fichera A. Recurrent CD: Surgical Prophylaxis-Kono-S anastomosis. In: Fichera A, Krane M. , eds. Crohn's Disease: Basic Principles. Switzerland: Springer; 2015: 227-236 . DOI 10.1007/978-3-319-14181-7
    Google Scholar
  • 17 Fazio VW, Marchetti F, Church M. et al. Effect of resection margins on the recurrence of Crohn's disease in the small bowel. A randomized controlled trial. Ann Surg 1996; 224 (04) 563-571 , discussion 571–573
    CrossrefPubMedGoogle Scholar
  • 18 Carr ND, Pullan BR, Schofield PF. Microvascular studies in non-specific inflammatory bowel disease. Gut 1986; 27 (05) 542-549
    CrossrefPubMedGoogle Scholar
  • 19 Hultén L, Lindhagen J, Lundgren O, Fasth S, Ahrén C. Regional intestinal blood flow in ulcerative colitis and Crohn's disease. Gastroenterology 1977; 72 (03) 388-396
    CrossrefPubMedGoogle Scholar
  • 20 Nakayama S, Hasegawa S, Nagayama S. et al. The importance of precompression time for secure stapling with a linear stapler. Surg Endosc 2011; 25 (07) 2382-2386
    CrossrefPubMedGoogle Scholar
  • 21 Caprilli R, Corrao G, Taddei G, Tonelli F, Torchio P, Viscido A. Prognostic factors for postoperative recurrence of Crohn's disease. Gruppo Italiano per lo Studio del Colon e del Retto (GISC). Dis Colon Rectum 1996; 39 (03) 335-341
    CrossrefPubMedGoogle Scholar
  • 22 McLeod RS, Wolff BG, Ross S, Parkes R, McKenzie M. ; Investigators of the CAST Trial. Recurrence of Crohn's disease after ileocolic resection is not affected by anastomotic type: results of a multicenter, randomized, controlled trial. Dis Colon Rectum 2009; 52 (05) 919-927
    CrossrefPubMedGoogle Scholar
  • 23 D'Haens GR, Geboes K, Peeters M, Baert F, Penninckx F, Rutgeerts P. Early lesions of recurrent Crohn's disease caused by infusion of intestinal contents in excluded ileum. Gastroenterology 1998; 114 (02) 262-267
    CrossrefPubMedGoogle Scholar
  • 24 Angerson WJ, Allison MC, Baxter JN, Russell RI. Neoterminal ileal blood flow after ileocolonic resection for Crohn's disease. Gut 1993; 34 (11) 1531-1534
    CrossrefPubMedGoogle Scholar
  • 25 Coffey CJ, Kiernan MG, Sahebally SM. et al. Inclusion of the mesentery in ileocolic resection for Crohn's disease is associated with reduced surgical recurrence. J Crohn's Colitis 2018; 12 (10) 1139-1150
    CrossrefPubMedGoogle Scholar