84 - Freie Mitteilung
17. Mai 2019, 08:15 - 09:45, Bellavista 5, 6. OG
Kono-S anastomosis in Crohn’s disease. Short-term results of a wide antimesenteric functional end-to-end anastomosis for ileocecal resection
K. Horisberger, D. Birrer, A. Rickenbacher, D. Cabalzar, M. Turina, Presenter: K. Horisberger (Zürich)
The most frequent long-term complication after ileocecal (IC) resection in Crohn’s disease is anastomotic recurrence and subsequent stenosis. Kono-S anastomosis is a hand-sewn antimesenteric functional end-to-end anastomosis that offers a wide lumen. Other issues are that stapled suture lines as well as side-to-side anastomoses are less accessible for endoscopic dilatation; both problems are avoided by this technique.
This is a retrospective cohort study of patients with Kono-S anastomosis. The medical records of all consecutive patients with Crohn’s disease undergoing IC resection or resection of the anastomosis after IC resection 01.04. - 31.12.2018 were queried for patients’ characteristics as well as specific data for the surgical procedure and short-term outcome.
15 patients were operated using a Kono-S anastomosis for Crohn’s disease of the terminal ileum (n=14) or recurrence at the level of the ileocolic anastomosis (n=1). In ten patients, resection was performed laparoscopically (n=8) or laparoscopically assisted (n=2). In five patients, resection had to be performed open, either due to intraabdominal abscess formation (n=3), or due to previous operations (n=2). The Kono S anastomosis was extraabdominally hand-sewn. Length of operation was 244 min [median, range170-360]. In all but four patients, IC resection was made in combination with an additional surgical procedure. In the four patients with exclusive laparoscopic IC-resection, length of operation was 185 min [median, r 170-234]. Postoperative complications with a Clavien-Dindo Score > IIIb were observed in two patients. One patient showed a hemorrhage from the resection margin of the meso and had to undergo surgical hemostasis. One patient developed anastomotic leakage on day five and had to undergo surgical revision. Median hospital stay was 9 days [r 5-28]. Follow-up is 4 months [median; r 0-8].
First results of the technique show that short-term results of this anastomosis are favorable and comparable to other techniques such as functional end-end anastomosis. Longer operation times than with conventional anastomosis are observed but published data concerning long-term recurrence are promising. Considering the lower likelihood of subsequent stenosis with recurrent Crohn’s disease, the Kono-S anastomosis may evolve to become the preferred technique for ileocecal resection in affected patients.