Ziegler Olivia, Moyer Amber M, Park Ji Ho, Quattrone Mckell, Kulaylat Audrey S, Deutsch Michael J, Jeganathan N Arjun, Koltun Walter A, Scow Jeffrey S
Department of Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania.
Division of Colon and Rectal Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania.
J Surg Res. 2024 Dec;304:74-80. doi: 10.1016/j.jss.2024.10.015. Epub 2024 Nov 12.
The Kono-S (KS) anastomosis for Crohn's disease (CD) is associated with improved endoscopic and clinical long-term outcomes. Ileocolonic anastomoses in CD are associated with an unacceptable anastomotic complication rate - up to 40%. Investigation of short-term benefits of KS is thus warranted. Here, we evaluate 90-d postoperative complications following KS versus side-to-side stapled anastomosis in patients with CD.
This is a retrospective case-control conducted at our tertiary medical center; data retrieved are from cases between January 2019 and May 2023. Thirty-eight consecutive patients with CD who underwent KS were matched with 38 patients who underwent side-to-side stapled anastomosis. Patients were initially age and sex matched; then, characteristics including body mass index, American Society of Anesthesiologists class, and disease severity indicated by inpatient status, preoperative laboratory values, steroid and disease modifying drug use were compared between cases and controls, using chi square, t-test, or Mann-Whitney U test.
Cohorts did not differ in the aforementioned characteristics with the exception of higher preoperative erythrocyte sedimentation rate in the KS group. There was no difference in operative approach, or complications between groups; one patient undergoing KS required return to operating room for fascial dehiscence, while two in the side-to-side stapled group required return to operating room for anastomotic complications. KS operative times were significantly longer.
KS is associated with an acceptable rate of short-term complications. In our matched series of 38 patients, we had no anastomotic leaks or bleeds in our KS group. Adoption of this technique may provide immediate postoperative benefits in addition to long-term disease reduction.
用于克罗恩病（CD）的科诺-S（KS）吻合术与改善内镜及临床长期预后相关。CD患者的回结肠吻合术的吻合口并发症发生率高达40%，令人难以接受。因此，有必要研究KS的短期益处。在此，我们评估了CD患者行KS与侧侧吻合器吻合术后90天的并发症情况。
这是一项在我们三级医疗中心进行的回顾性病例对照研究；检索的数据来自2019年1月至2023年5月期间的病例。38例连续接受KS的CD患者与38例行侧侧吻合器吻合术的患者进行匹配。患者最初按年龄和性别匹配；然后，使用卡方检验、t检验或曼-惠特尼U检验比较病例组和对照组之间的特征，包括体重指数、美国麻醉医师协会分级以及由住院状态、术前实验室值、类固醇和疾病修饰药物使用情况所表明的疾病严重程度。
除KS组术前红细胞沉降率较高外，两组在上述特征方面无差异。两组在手术方式或并发症方面无差异；1例接受KS的患者因筋膜裂开需要返回手术室，而侧侧吻合组有2例因吻合口并发症需要返回手术室。KS的手术时间明显更长。
KS的短期并发症发生率可以接受。在我们匹配的38例患者系列中，KS组没有吻合口漏血或出血情况。采用该技术除了能长期减轻疾病外，还可能在术后立即带来益处。
