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