Effect of Kono-S anastomosis on reducing postoperative recurrence rates in Crohn’s disease: a systematic review and meta-analysis

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Techniques in Coloproctology Pub Date : 2024-09-18 DOI:10.1007/s10151-024-02991-7

W. Lin, M. Lemke, A. Ghuman, P. T. Phang, C. J. Brown, M. J. Raval, E. A. Clement, A. A. Karimuddin

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Abstract

Background

Kono-S anastomosis has gained increasing interest although evaluation of its impact on reducing Crohn’s recurrence shows conflicting results. This study aimed to evaluate the short- and long-term outcomes for patients with Crohn’s disease requiring surgery with Kono-S compared to conventional anastomosis.

Methods

A systematic review and meta-analysis included patients with Crohn’s disease treated with bowel resection and Kono-S anastomosis reconstruction versus a comparator arm of conventional anastomosis technique. Recurrence outcomes examined were endoscopic recurrence rates, mean postoperative Rutgeerts score, surgical recurrence, clinical recurrence, and postoperative biologics use. Short-term postoperative outcomes include anastomotic leaks, surgical site infection, postoperative ileus, and mean operative time.

Results

A total of 873 studies were identified with 15 remaining after abstract review encompassing 1501 patients, 765 with Kono-S and 736 with conventional anastomosis. Recurrence was significantly lower in the Kono-S arm, with endoscopic recurrence rates of 41% vs 48% (RR 0.86, 95% CI 0.73–1.00, p = 0.05) and surgical recurrence rates of 2.7% vs 21.0% (RR 0.13, 95% CI 0.06–0.30, p < 0.001). There was a significantly lower anastomotic leak rate in the Kono-S arm when compared to conventional anastomosis, 1.7% vs 4.9% (RR 0.37, 95% CI 0.19–0.74, p = 0.005). Mean operative time was similar between both groups.

Conclusions

Kono-S is a safe and feasible anastomotic technique with lower rates of endoscopic and surgical postoperative recurrence. While we await further trials to substantiate this benefit, Kono-S anastomosis should be considered as an important tool in the armamentarium of a surgeon in anastomotic construction to reduce recurrence.

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Kono-S吻合术对降低克罗恩病术后复发率的影响：系统综述与荟萃分析

背景Kono-S吻合术受到越来越多的关注，但对其减少克罗恩病复发影响的评估结果却相互矛盾。本研究旨在评估需要使用 Kono-S 与传统吻合术进行手术的克罗恩病患者的短期和长期疗效。方法系统回顾和荟萃分析纳入了接受肠切除术和 Kono-S 吻合术重建治疗的克罗恩病患者，以及采用传统吻合术的比较组患者。复发结果包括内镜复发率、术后 Rutgeerts 平均评分、手术复发、临床复发和术后生物制剂的使用。术后短期疗效包括吻合口渗漏、手术部位感染、术后回肠梗阻和平均手术时间。结果共发现 873 项研究，摘要审查后剩余 15 项，涉及 1501 例患者，其中 765 例采用 Kono-S 吻合术，736 例采用传统吻合术。Kono-S 治疗组的复发率明显较低，内镜复发率为 41% vs 48%（RR 0.86，95% CI 0.73-1.00，p = 0.05），手术复发率为 2.7% vs 21.0%（RR 0.13，95% CI 0.06-0.30，p <0.001）。与传统吻合术相比，Kono-S手术组的吻合口漏率明显降低，为1.7% vs 4.9% (RR 0.37, 95% CI 0.19-0.74, p = 0.005)。结论Kono-S是一种安全可行的吻合技术，内镜和手术术后复发率较低。尽管我们还在等待进一步的试验来证实这一优势，但 Kono-S 吻合术应被视为外科医生在吻合器构建中减少复发的重要工具。

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来源期刊

Techniques in Coloproctology GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.30

自引率

9.10%

发文量

176

审稿时长

1 months

期刊介绍： Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.