BACKGROUND:

Postoperative recurrence remains a significant problem in Crohn’s disease, and the mesentery is implicated in the pathophysiology. The Kono-S anastomosis was designed to exclude the mesentery from a wide anastomotic lumen, limit luminal distortion and fecal stasis, and preserve innervation and vascularization.

OBJECTIVE:

To review postoperative complications and long-term outcomes of the Kono-S anastomosis in a large series of consecutive unselected patients with Crohn’s disease.

DESIGN:

Retrospective study of prospectively collected patients.

SETTINGS:

Four tertiary referral centers.

PATIENTS:

Consecutive patients with Crohn’s disease who underwent resection with Kono-S anastomosis between May 2010 and June 2022.

INTERVENTIONS:

Extracorporeal handsewn Kono-S anastomosis.

MAIN OUTCOME MEASURES:

Postoperative outcomes and recurrence defined as endoscopic, clinical, laboratory, or surgical, including endoscopic, intervention.

RESULTS:

A total of 262 consecutive patients (53.4% male) were included. The mean duration of disease at surgery was 145.1 months. One hundred thirty-five patients (51.5%) had previous abdominal surgery for Crohn’s disease. Forty-four patients (17%) were actively smoking and 150 (57.3%) were on biologic therapy. Anastomotic failure occurred in 4 (1.5%), with 2 patients requiring reoperation (0.7%). Sixteen patients had postoperative surgical site infection (6.1%). With a median follow-up of 49.4 months, 20 patients (7.6%) were found to have surgical recurrence. In the multivariate analysis, perianal disease (OR= 2.83, p= 0.001), urgent/emergent surgery (OR= 3.23, p= 0.007), and postoperative use of steroids (OR= 2.29, p= 0.025) were associated with increased risk of overall recurrence.

LIMITATIONS:

Retrospective study and variability of perioperative medical therapy.

CONCLUSIONS:

This study showed very low postoperative complication rates despite the complexity of the patient population. There was a low rate of surgical recurrence, likely due to the intrinsic advantages of the anastomotic configuration and the low rate of postoperative septic complications. In experienced hands, the Kono-S anastomosis is a safe technique with very promising short-and long-term results. Randomized controlled trials are underway to validate this study's findings. See Video Abstract.