Citation Information :
Saeed M, Algahiny AT, Elmitwalli OS, Ahmed MM, Juma IM. An Analysis of the Literature and a Case Study on the Successful Surgical Treatment of a Crohn's Patient Using a Kono-S Anastomosis. Euroasian J Hepatogastroenterol 2023; 13 (1):36-39.
Background: Crohn's disease (CD) is a chronic inflammatory bowel disease affecting the gastrointestinal tract. Treatment involves immunosuppression, and surgical intervention is sometimes necessary for patients who do not respond to medical treatment. However, recurrence of the disease is a common complication after surgery.
Aim: This case report focuses on a patient with CD who underwent ileocecal resection with Kono-S anastomosis, a surgical technique aimed at reducing recurrence rates.
Case description: A 43-year-old male with a known history of CD for 13 years presented with recurring moderate-to-severe lower abdominal pain associated with belching, nausea, subjective fever, and sweats. The patient was on infliximab and azathioprine. Investigations confirmed irregular skip mural thickening of ileal loops with significant luminal narrowing along with stenotic fibrostrictures of the ileum, and mild bilateral sacroiliitis. The patient was treated surgically with an ileocecal resection and a Kono-S anastomosis operation. This case report highlights the advantages and disadvantages of the Kono-S anastomosis technique in treating patients with recurrent CD.
Clinical significance: Kono-S anastomosis demonstrates a relative safety profile and carries several potential benefits. However, its wider adoption is limited due to insufficient familiarity among surgeons and the possibility of complications. Nevertheless, embracing Kono-S as the standard anastomosis method holds the promise of significant advantages for individuals with CD.
Conclusion: This case report highlights the potential benefits of Kono-S anastomosis in reducing CD recurrence and provides valuable insights for further research and clinical practice.
Horisberger K, Birrer DL, Rickenbacher A, et al. Experiences with the Kono-S anastomosis in Crohn's disease of the terminal ileum: A cohort study. Langenbecks Arch Surg 2021;406(4):1173–1180. DOI: 10.1007/s00423-020-01998-6
Eto S, Yoshikawa K, Iwata T, et al. Kono-S anastomosis for Crohn's disease: Report of 2 cases. Int Surg 2019;104(11–12):534–539. DOI: 10.9738/INTSURG-D-15-00076.1.
Peyrin–Biroulet L, Loftus EV Jr, Colombel JF, et al. The natural history of adult Crohn's disease in population-based cohorts. Am J Gastroenterol 2010;105(2):289–297. DOI: 10.1038/ajg.2009.579.
Ibrahim R, Abounozha S, Kheder A, et al. Does anastomotic technique affects the recurrence rate of Crohn's disease after ileocolic resection? Ann Med Surg (Lond) 2021;62:164–167. DOI: 10.1016/j.amsu.2021.01.027.
McLeod RS, Wolff BG, Ross S, et al. Recurrence of Crohn's disease after ileocolic resection is not affected by anastomotic type: Results of a multicenter, randomized, controlled trial. Dis Colon Rectum 2009;52(5):919–927. DOI: 10.1007/DCR.0b013e3181a4fa58.
Gionchetti P, Dignass A, Danese S, et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn's disease 2016: Part 2: Surgical management and special situations. J Crohns Colitis 2017;11(2):135–149. DOI: 10.1093/ecco-jcc/jjw169.
Bernell O, Lapidus A, Hellers G. Risk factors for surgery and recurrence in 907 patients with primary ileocaecal Crohn's disease. Br J Surg 2000;87(12):1697–1701. DOI: 10.1046/j.1365-2168.2000.01589.x.
Seyfried S, Post S, Kienle P, et al. The Kono-S anastomosis in surgery for Crohn's disease: First results of a new functional end-to-end anastomotic technique after intestinal resection in patients with Crohn's disease in Germany. Chirurg 2019;90(2):131–136. DOI: 10.1007/s00104-018-0668-4.
Kono T, Ashida T, Ebisawa Y, et al. A new antimesenteric functional end-to-end handsewn anastomosis: Surgical prevention of anastomotic Recurrence in Crohn's disease. Dis Colon Rectum 2011;54(5):586–592. DOI: 10.1007/DCR.0b013e318208b90f.
ASCRS Toolkit – FREE Resources. Episode 1: Should Kono-S be preferred anastomotic technique for ileocolic Crohn's disease? Available at: https://www.ascrsu.com/ascrs/view/ASCRS- Toolkit/2851084/all/Episode_1:_Should_Kono_S_Be_Preferred_Anastomotic_Techniq.... Accessed on: 25 March 2023.
Luglio G, Rispo A, Imperatore N, et al. Surgical prevention of anastomotic recurrence by excluding mesentery in Crohn's disease: The supreme-CD study—a randomized clinical trial. Ann Surg 2020;272(2):210–217. DOI: 10.1097/sla.0000000000003821.
Alshantti A, Hind D, Hancock L, et al. The role of Kono-S anastomosis and mesenteric resection in reducing recurrence after surgery for Crohn's disease. A systematic review. Colorectal Dis 2021;23(1):7–17. DOI: 10.1111/codi.15136.
Dasharathy SS, Limketkai BN, Sauk JS: What's new in the postoperative management of Crohn's disease? Digestive Dis Sci 2022; 67(8):3508–3517. DOI: 10.1007/s10620-021-07205-w.
Kono T, Fichera A. Surgical treatment for Crohn's disease: A role of Kono-S anastomosis in the West. Clin Colon Rectal Surg 2020;33(6):335–343. DOI: 10.1055/s-0040-1714236.