Division of Gastroenterologic and General Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan.
Dis Colon Rectum. 2011 May;54(5):586-92. doi: 10.1007/DCR.0b013e318208b90f.
Recurrence of Crohn's disease usually occurs at anastomotic sites.
A new anastomosis technique (Kono-S anastomosis) designed to minimize anastomotic restenosis was compared with conventional anastomoses.
The Kono-S anastomosis technique was first used for Crohn's disease in 2003 at the Asahikawa Medical University Hospital. The resection is accomplished by transecting the bowel with a linear cutter so that the mesentery side is located in the center of the stump. Both stumps are sutured to create a supporting column to maintain the diameter and dimension of the anastomosis. Longitudinal enterotomies are made at the antimesenteric sides of the 2 segments of intestine. The side-to-side antimesenteric anastomosis is then performed in transverse fashion. The medical records and follow-up details of all patients undergoing this procedure were reviewed.
: From 2003 to 2009, 69 patients with Crohn's disease who underwent Kono-S anastomosis (group S) were compared with 73 historical patients with Crohn's disease who underwent conventional anastomosis (group C) from 1993 to 2003.
A Kaplan-Meier analysis of the follow-up data on surgical recurrence at the anastomosis was performed. The endoscopic recurrence score at the anastomosis was calculated.
The median endoscopic recurrence score in group S was significantly lower than that in group C (2.6 vs 3.4; P = .008). The Kaplan-Meier analysis showed a lesser probability of anastomotic surgical recurrence in the S group at 5 years (0% vs 15%; P = .0013). The absence of postoperative infliximab did not affect the restenosis rate in group S.
This study was limited by its historical retrospective nature.
The Kono-S anastomosis appears to be effective in preventing anastomotic surgical recurrence in Crohn's disease.
克罗恩病的复发通常发生在吻合口部位。
与传统吻合术相比，我们比较了一种旨在最小化吻合口再狭窄的新型吻合术（Kono-S 吻合术）。
Kono-S 吻合术于 2003 年在旭川医科大学医院首次用于克罗恩病。通过线性切割器横断肠管，使肠系膜侧位于残端的中心来完成切除。两残端缝合以形成支撑柱，以维持吻合口的直径和尺寸。在两段肠的对系膜侧做纵向肠切开术。然后以横断方式进行侧侧对系膜吻合术。回顾性分析所有接受该手术的患者的病历和随访资料。
2003 年至 2009 年，69 例克罗恩病患者接受 Kono-S 吻合术（S 组），与 1993 年至 2003 年接受传统吻合术（C 组）的 73 例克罗恩病患者进行比较。
对吻合口手术复发的随访数据进行 Kaplan-Meier 分析。计算吻合口内镜复发评分。
S 组的中位内镜复发评分明显低于 C 组（2.6 比 3.4；P=0.008）。Kaplan-Meier 分析显示，S 组 5 年时吻合口手术复发的可能性较小（0%比 15%；P=0.0013）。S 组中术后未使用英夫利昔单抗并不影响再狭窄率。
本研究受到其历史回顾性的限制。
Kono-S 吻合术似乎能有效预防克罗恩病吻合口手术复发。
