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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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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

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Authors and Affiliations

  1. Department of Surgery, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, Japan

    Norimitsu Shimada, Hiroki Ohge, Raita Yano, Yusuke Watadani, Kenichiro Uemura, Yoshiaki Murakami & Taijiro Sueda

  2. Center for Clinical and Biomedical Research, Sapporo Higashi Tokushukai Hospital, 3-1, Kita 33-jo Higashi, 14-chome, Higashi-ku, Sapporo, Hokkaido, 065-0033, Japan

    Toru Kono & Ayumu Sugitani

Authors
  1. Norimitsu Shimada
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  3. Toru Kono
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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

Corresponding author

Correspondence to Norimitsu Shimada.

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Conflict of Interest

The authors declare that they have no conflicts of interest

Additional information

Conference presentation: This study was presented as a poster at the 2017 meeting of The American Society of Colon and Rectal Surgeons in Seattle, Washington (10–14 June 2017).

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Shimada, N., Ohge, H., Kono, T. et al. Surgical Recurrence at Anastomotic Site After Bowel Resection in Crohn’s Disease: Comparison of Kono-S and End-to-end Anastomosis. J Gastrointest Surg 23, 312–319 (2019). https://doi.org/10.1007/s11605-018-4012-6

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  • DOI: https://doi.org/10.1007/s11605-018-4012-6

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