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
› Author Affiliations

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.



Publication History

Article published online:
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
  • 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
  • 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
  • 4 Nos P, Domenech E. Postoperative Crohn's disease recurrence: a practical approach. World J Gastroenterol 2008; 14 (36) 5540-5548
  • 5 Terdiman JP. Prevention of postoperative recurrence in Crohn's disease. Clin Gastroenterol Hepatol 2008; 6 (06) 616-620
  • 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
  • 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
  • 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
  • 9 Yamamoto T, Watanabe T. Surgery for luminal Crohn's disease. World J Gastroenterol 2014; 20 (01) 78-90
  • 10 Michelassi F. Crohn's recurrence after intestinal resection and anastomosis. Dig Dis Sci 2014; 59 (07) 1352-1353
  • 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
  • 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
  • 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
  • 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
  • 15 Fichera A, Zoccali M, Kono T. Antimesenteric functional end-to-end handsewn (Kono-S) anastomosis. J Gastrointest Surg 2012; 16 (07) 1412-1416
  • 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
  • 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
  • 18 Carr ND, Pullan BR, Schofield PF. Microvascular studies in non-specific inflammatory bowel disease. Gut 1986; 27 (05) 542-549
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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