P327. Efficacy of a new antimesenteric functional end-to-end anastomosis for prevention of surgical recurrences after resection for Crohn's disease: A multicenter study in Japan and the United States
T. Kono1, A. Fichera2, Y. Ebisawa1, N. Chisato1, T. Okayama1, H. Furukawa1, K. Okamoto3, M. Fujiya3, T. Ashida4, Y. Kohgo3, M. Yamada5, Y. Sakai5, W. Shimizu6, M. Uegami6, H. Ohge6, H. Katsuno7, H. Masumori7, T. Hanai7, K. Maeda7, S. Hanauer8
1Asahikawa Medical University, Surgery, Japan; 2University of Chicago Medical Center, Surgery, Chicago, United States; 3Asahikawa Medical University, Internal Medicine, Japan; 4Higashi Tokusyukai Hospital, Center for IBD, Japan; 5Kyoto University, Surgery, Japan; 6Hiroshima University, Surgery, Japan; 7Fujita Health University, Surgery, Japan; 8University of Chicago Medical Center, Center for Advanced Medicine, Chicago, United States
Background: Anastomotic recurrence and restenosis after bowel resection is a major problem in Crohn's disease (CD). A new combined stapled and hand-sewn antimesenteric functional end-to-end anastomosis (Kono‑S anastomosis) was designed to minimize anastomotic restenosis in 2003 at the Asahikawa Medical University Hospital (Dis Colon Rectum 54, 586, 2011). The objective of this retrospective multicenter study was to analyze the outcomes of Kono‑S anastomosis.
Methods: The medical records and follow-up details of 188 CD patients (140 Japanese and 48 American) who underwent Kono‑S anastomosis at five hospitals (four in Japan and one in the United States) from 2003 to 2011 were reviewed. Surgical recurrence at the anastomosis was analyzed from the follow-up data by the Kaplan–Meier method. The Kono‑S anastomosis technique was accomplished by transecting the bowel with a linear cutter so that the mesentery side was located in the center of the stump. Both stumps were sutured to create a supporting column to maintain the diameter and dimension of the anastomosis. Longitudinal enterotomies were made at the antimesenteric sides of the two segments of intestine. The side-to-side antimesenteric anastomosis was then performed in a transverse fashion.
Results: The Kono‑S anastomosis was successfully performed in all 188 patients with excellent results. No deaths were reported and only two anastomotic leaks (1%) occurred during the study period. The Kaplan–Meier analysis showed no anastomotic surgical recurrence at 8 years. The absence of postoperative infliximab did not affect the restenosis rate
Conclusions: The Kono‑S anastomosis is a technically feasible procedure that appears to be safe and effective in preventing anastomotic surgical recurrence in CD, although prospective studies are needed to confirm our findings.