Liao Xiujun, Cricrì Michele, Tang Yang, Sun Pan, Mongardini Massimo, Docimo Ludovico, Tolone Salvatore, Mongardini Federico Maria
Department of Colorectal Surgery and Oncology (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Center for Medical Research and Innovation in Digestive System Tumors, Ministry of Education, Hangzhou, China.
Updates Surg. 2025 Apr;77(2):355-361. doi: 10.1007/s13304-025-02122-3. Epub 2025 Feb 2.
Crohn's disease (CD) is a chronic immune-mediated disorder affecting the gastrointestinal tract. While medical therapies have advanced, approximately 80% of CD patients will require surgery due to disease recurrence. A significant debate exists regarding the primary site of post-operative recurrence. This discrepancy in recurrence patterns underscores the complexity of CD management and the ongoing need for tailored surgical approaches. It has been recently demonstrated that the Kono-S anastomosis is safe and efficient in reducing endoscopic and surgical recurrence. Newer versions of the Kono-S anastomosis using staplers have been reported to further simplify the procedure and decrease operative time. The aim of this paper was to describe a distinct version of a totally stapled Kono-S anastomosis and provide preliminary results from our center. The technical procedure of a totally stapled Kono-S anastomosis is illustrated. A consecutive series of patients undergoing ileal or ileo-colic resection followed by totally stapled Kono-S anastomosis was identified from a prospectively collated database. Data included patient demographics and baseline characteristics, intraoperative details, short- and long-term post-operative outcomes. Between January and November 2023, 41 patients (mean age 36.4 years, 61% males) underwent ileal or ileo-colic resection followed by totally stapled Kono-S anastomosis for Crohn's disease. Mean operative time was 150.76 ± 43.22 min, and mean time of anastomotic construction was 19.71 ± 4.24. Time to flatus and stool were 2.73 ± 0.70 and 3.51 ± 1.16 days, respectively, and the length of post-operative stay was 6.80 ± 2.13 days. Only two patients (4.8%) presented complications following surgery, namely anastomotic bleeding. At a mean follow-up of 17.0 ± 2.1 months, no patient needed re-do surgery for disease recurrence at anastomotic site. The endoscopic recurrence rate was 14.4% (4/28). Our fully stapled version of the Kono-S anastomosis is safe and feasible, and short construction time and low technical complexity may help its diffusion among colorectal surgeons. Long-term outcomes on disease recurrence are still to be defined.
克罗恩病（CD）是一种影响胃肠道的慢性免疫介导性疾病。尽管医学治疗有所进步，但约80%的CD患者因疾病复发需要手术治疗。关于术后复发的主要部位存在重大争议。复发模式的这种差异凸显了CD管理的复杂性以及对量身定制的手术方法的持续需求。最近有研究表明，Kono-S吻合术在降低内镜及手术复发方面安全且有效。据报道，使用吻合器的新型Kono-S吻合术进一步简化了手术过程并缩短了手术时间。本文旨在描述一种完全使用吻合器的Kono-S吻合术的独特术式，并提供我们中心的初步结果。文中阐述了完全使用吻合器的Kono-S吻合术的技术操作过程。从一个前瞻性整理的数据库中确定了一系列连续接受回肠或回结肠切除并随后进行完全使用吻合器的Kono-S吻合术的患者。数据包括患者人口统计学和基线特征、术中细节、术后短期和长期结果。2023年1月至11月期间，41例患者（平均年龄36.4岁，61%为男性）因克罗恩病接受了回肠或回结肠切除并随后进行了完全使用吻合器的Kono-S吻合术。平均手术时间为150.76±43.22分钟，平均吻合构建时间为19.71±4.24分钟。排气时间和排便时间分别为2.73±0.70天和3.51±1.16天，术后住院时间为6.80±2.13天。仅2例患者（4.8%）术后出现并发症，即吻合口出血。平均随访17.0±2.1个月时，无患者因吻合口部位疾病复发需要再次手术。内镜复发率为14.4%（4/28）。我们的完全使用吻合器的Kono-S吻合术安全可行，构建时间短且技术复杂性低，这可能有助于其在结直肠外科医生中推广。疾病复发的长期结果仍有待确定。
