Long-term Outcome of the Kono-S Anastomosis: A Multicenter Study

Abstract

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 undergoing 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. 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), postoperative use of steroids (OR=2.29, p = 0.025) were associated with increased risk of overall recurrence. LIMITATION: Retrospective study. Variability of perioperative medical therapy. CONCLUSIONS: Our 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 control trials are underway to validate our findings.