Journal of Gastrointestinal Surgery

, Volume 23, Issue 2, pp 312–319 | Cite as

Surgical Recurrence at Anastomotic Site After Bowel Resection in Crohn’s Disease: Comparison of Kono-S and End-to-end Anastomosis

  • Norimitsu ShimadaEmail author
  • Hiroki Ohge
  • Toru Kono
  • Ayumu Sugitani
  • Raita Yano
  • Yusuke Watadani
  • Kenichiro Uemura
  • Yoshiaki Murakami
  • Taijiro Sueda
Original Article



Anastomotic surgical recurrence after bowel resection in Crohn’s disease patients is problematic. This study was performed to evaluate the increased risk of anastomotic surgical recurrence.


From 2006 to 2016, we performed anastomoses in 215 consecutive Crohn’s disease patients. The cohort was divided into two groups: Kono-S anastomosis (n = 117) and end-to-end anastomosis (n = 98). Multivariate analysis of predictors of anastomotic surgical recurrence and Kaplan–Meier analysis for the 5-year anastomotic surgical recurrence rate were evaluated.


The two groups showed no statistically significant differences in patient backgrounds. During a median follow-up of 54 months, 28 patients required anastomotic surgical recurrence [4 (3.4%) in the Kono-S group and 24 (24.4%) in the end-to-end group]. Six leaks (5.1%) were detected in the Kono-S group and 17 leaks (17.3%) in the end-to-end group; all were successfully treated conservatively. End-to-end anastomosis, leakage, age < 45 years, and body mass index of ≥ 18 kg/m2 at the first surgery had a higher risk of anastomotic surgical recurrence. Kono-S anastomosis significantly reduced the risk of anastomotic surgical recurrence after 1 year (odds ratio, 0.14). Anastomotic leakage influenced anastomotic surgical recurrence within 1 year (odds ratio, 4.84). The 5-year surgery-free survival rate at the anastomosis site with Kono-S anastomosis (95.0%) was significantly higher than that with end-to-end anastomosis (81.3%; P < 0.001).


Anastomotic leakage after bowel resection in Crohn’s disease patients increased anastomotic surgical recurrence within 1 year, and Kono-S anastomosis is associated with a low risk of anastomotic surgical recurrence after > 1 year.


Crohn’s disease Surgical recurrence Anastomosis End-to-end Kono-S anastomosis 


Authors’ Contributions

Study conception: Norimitsu Shimada, Hiroki Ohge, Toru Kono, Taijiro Sueda

Study design: Norimitsu Shimada, Hiroki Ohge, Toru Kono

Data acquisition: Norimitsu Shimada, Raita Yano, Yusuke Watadani

Quality control of data and algorithms: Yusuke Watadani, Kenichiro Uemura, Yoshiaki Murakami

Data analysis and interpretation: Norimitsu Shimada, Ayumu Sugitani, Raita Yano

Statistical analysis: Ayumu Sugitani

Manuscript preparation: Norimitsu Shimada

Manuscript editing: Hiroki Ohge, Yoshiaki Murakami, Kenichiro Uemura

Manuscript review: Toru Kono, Taijiro Sueda

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest


  1. 1.
    Bernell O, Lapidus A, Hellers G. Risk factors for surgery and postoperative recurrence in Crohn’s disease. Annals of surgery. 2000;231(1):38–45.CrossRefPubMedCentralGoogle Scholar
  2. 2.
    Lewis RT, Maron DJ. Efficacy and complications of surgery for Crohn’s disease. Gastroenterology & hepatology. 2010;6(9):587–96.Google Scholar
  3. 3.
    Michelassi F. Crohn’s recurrence after intestinal resection and anastomosis. Digestive diseases and sciences. 2014;59(7):1352–3. Scholar
  4. 4.
    Olaison G, Smedh K, Sjodahl R. Natural course of Crohn’s disease after ileocolic resection: endoscopically visualised ileal ulcers preceding symptoms. Gut. 1992;33(3):331–5.CrossRefPubMedCentralGoogle Scholar
  5. 5.
    Peyrin-Biroulet L, Harmsen WS, Tremaine WJ, Zinsmeister AR, Sandborn WJ, Loftus EV, Jr. Surgery in a population-based cohort of Crohn’s disease from Olmsted County, Minnesota (1970-2004). Am J Gastroenterol. 2012;107(11):1693–701. Scholar
  6. 6.
    Cho SM, Cho SW, Regueiro M. Postoperative management of crohn disease. Gastroenterol Clin North Am. 2009;38(4):753–62.CrossRefGoogle Scholar
  7. 7.
    Peyrin-Biroulet L, Loftus EV, Jr., Colombel JF, Sandborn WJ. The natural history of adult Crohn’s disease in population-based cohorts. The American journal of gastroenterology. 2010;105(2):289–97. Scholar
  8. 8.
    He X, Chen Z, Huang J, Lian L, Rouniyar S, Wu X et al. Stapled side-to-side anastomosis might be better than handsewn end-to-end anastomosis in ileocolic resection for Crohn’s disease: a meta-analysis. Digestive diseases and sciences. 2014;59(7):1544–51. Scholar
  9. 9.
    McLeod RS, Wolff BG, Ross S, Parkes R, McKenzie M. 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):919–27.CrossRefGoogle Scholar
  10. 10.
    Kono T, Ashida T, Ebisawa Y, Chisato N, Okamoto K, Katsuno H 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):586–92. Scholar
  11. 11.
    Kono T, Fichera A, Maeda K, Sakai Y, Ohge H, Krane M et al. Kono-S Anastomosis for Surgical Prophylaxis of Anastomotic Recurrence in Crohn’s Disease: an International Multicenter Study. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2016;20(4):783–90. CrossRefGoogle Scholar
  12. 12.
    Fichera A, Zoccali M, Kono T. Antimesenteric functional end-to-end handsewn (Kono-S) anastomosis. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2012;16(7):1412–6. CrossRefGoogle Scholar
  13. 13.
    Katsuno H, Maeda K, Hanai T, Masumori K, Koide Y, Kono T. Novel antimesenteric functional end-to-end handsewn (Kono-S) anastomoses for Crohn’s disease: a report of surgical procedure and short-term outcomes. Digestive surgery. 2015;32(1):39–44. Scholar
  14. 14.
    Luglio G, Rispo A, Castiglione F, Imperatore N, Giglio MC, De Palma GD et al. Kono-type anastomosis in a patient with severe multi-recurrent Crohn’s disease. Int J Colorectal Dis. 2016;31(8):1565–6. Scholar
  15. 15.
    Fornaro R, Caratto E, Caratto M, Fornaro F, Caristo G, Frascio M et al. Post-operative recurrence in Crohn’s disease. Critical analysis of potential risk factors. An update. The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland. 2015;13(6):330–47. CrossRefGoogle Scholar
  16. 16.
    De Cruz P, Kamm MA, Prideaux L, Allen PB, Desmond PV. Postoperative recurrent luminal Crohn’s disease: a systematic review. Inflammatory bowel diseases. 2012;18(4):758–77. Scholar
  17. 17.
    de Barcelos IF, Kotze PG, Spinelli A, Suzuki Y, Teixeira FV, de Albuquerque IC et al. Factors affecting the incidence of early endoscopic recurrence after ileocolonic resection for Crohn’s disease: a multicentre observational study. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2017;19(1):O39-O45. CrossRefGoogle Scholar
  18. 18.
    Iesalnieks I, Kilger A, Glass H, Muller-Wille R, Klebl F, Ott C et al. Intraabdominal septic complications following bowel resection for Crohn’s disease: detrimental influence on long-term outcome. International journal of colorectal disease. 2008;23(12):1167–74. Scholar
  19. 19.
    Resegotti A, Astegiano M, Farina EC, Ciccone G, Avagnina G, Giustetto A et al. Side-to-side stapled anastomosis strongly reduces anastomotic leak rates in Crohn’s disease surgery. Dis Colon Rectum. 2005;48(3):464–8. Scholar
  20. 20.
    Widmar M, Cummings DR, Steinhagen E, Samson A, Barth AR, Greenstein AJ et al. Oversewing staple lines to prevent anastomotic complications in primary ileocolic resections for Crohn’s disease. J Gastrointest Surg. 2015;19(5):911–6. Scholar
  21. 21.
    Kusunoki M, Ikeuchi H, Yanagi H, Shoji Y, Yamamura T. A comparison of stapled and hand-sewn anastomoses in Crohn’s disease. Digestive surgery. 1998;15(6):679–82.CrossRefGoogle Scholar
  22. 22.
    Smedh K, Andersson M, Johansson H, Hagberg T. Preoperative management is more important than choice of sutured or stapled anastomosis in Crohn’s disease. The European journal of surgery = Acta chirurgica. 2002;168(3):154–7. Google Scholar
  23. 23.
    Yamamoto T, Allan RN, Keighley MR. Risk factors for intra-abdominal sepsis after surgery in Crohn’s disease. Dis Colon Rectum. 2000;43(8):1141–5.CrossRefGoogle Scholar
  24. 24.
    D’Haens GR, Geboes K, Peeters M, Baert F, Penninckx F, Rutgeerts P. Early lesions of recurrent Crohn’s disease caused by infusion of intestinal contents in excluded ileum. Gastroenterology. 1998;114(2):262–7.CrossRefGoogle Scholar
  25. 25.
    de Buck van Overstraeten A, Vermeire S, Vanbeckevoort D, Rimola J, Ferrante M, Van Assche G et al. Modified Side-To-Side Isoperistaltic Strictureplasty over the Ileocaecal Valve: An Alternative to Ileocaecal Resection in Extensive Terminal Ileal Crohn’s Disease. Journal of Crohn’s & colitis. 2016;10(4):437–42. Scholar
  26. 26.
    Blonski W, Buchner AM, Lichtenstein GR. Clinical predictors of aggressive/disabling disease: ulcerative colitis and crohn disease. Gastroenterol Clin North Am. 2012;41(2):443–62. Scholar
  27. 27.
    Gklavas A, Dellaportas D, Papaconstantinou I. Risk factors for postoperative recurrence of Crohn’s disease with emphasis on surgical predictors. Annals of gastroenterology. 2017;30(6):598–612. PubMedCentralGoogle Scholar
  28. 28.
    De Cruz P, Kamm MA, Hamilton AL, Ritchie KJ, Krejany EO, Gorelik A et al. Crohn’s disease management after intestinal resection: a randomised trial. Lancet (London, England). 2015;385(9976):1406–17. Scholar
  29. 29.
    Reese GE, Nanidis T, Borysiewicz C, Yamamoto T, Orchard T, Tekkis PP. The effect of smoking after surgery for Crohn’s disease: a meta-analysis of observational studies. Int J Colorectal Dis. 2008;23(12):1213–21. Scholar
  30. 30.
    Manser CN, Frei P, Grandinetti T, Biedermann L, Mwinyi J, Vavricka SR et al. Risk factors for repetitive ileocolic resection in patients with Crohn’s disease: results of an observational cohort study. Inflammatory bowel diseases. 2014;20(9):1548–54. Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Norimitsu Shimada
    • 1
    Email author
  • Hiroki Ohge
    • 1
  • Toru Kono
    • 2
  • Ayumu Sugitani
    • 2
  • Raita Yano
    • 1
  • Yusuke Watadani
    • 1
  • Kenichiro Uemura
    • 1
  • Yoshiaki Murakami
    • 1
  • Taijiro Sueda
    • 1
  1. 1.Department of SurgeryHiroshima UniversityHiroshima CityJapan
  2. 2.Center for Clinical and Biomedical ResearchSapporo Higashi Tokushukai HospitalSapporoJapan

Personalised recommendations