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Antimesenteric Functional End-to-End Handsewn (Kono-S) Anastomosis

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Abstract

Introduction

Anastomotic recurrence is a frequent event after bowel resection for Crohn’s disease. To date, no anastomotic technique has been proven to be superior in reducing surgical recurrence rates in this setting. In this article, we describe our technique in performing a new antimesenteric functional end-to-end handsewn (Kono-S) anastomosis.

Methods

The segment of bowel to be resected is identified and mobilized. The bowel is then divided transversely with a linear stapler–cutter device. The intervening mesentery is divided close to the bowel. The corners of the two stapled lines are sutured together, and the two stapled lines are approximated with interrupted sutures. An antimesenteric longitudinal enterotomy is performed on both sides, starting no more than 1 cm away from the staple line, to allow a transverse lumen of 7–8 cm. The openings are closed transversely in two layers.

Results

From May 1, 2010 to July 31, 2011 we performed 46 Kono-S anastomoses. One patient had a contained anastomotic leak successfully treated conservatively. Currently, 18 patients (43 %) have undergone follow-up endoscopic surveillance with an average Rutgeert’s score of 0.7 (0–3) at a mean of 6.8 months.

Conclusion

The Kono-S anastomosis is a safe anastomotic technique. Long-term studies are needed to confirm its efficacy in preventing surgical recurrence.

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Authors and Affiliations

  1. Department of Surgery, University of Chicago Medical Center, 5841 S. Maryland Avenue, MC 5095, Chicago, IL, 60637, USA

    Alessandro Fichera & Marco Zoccali

  2. First General Surgery Unit, Department of Surgery, Catholic University, Rome, Italy

    Marco Zoccali

  3. Department of Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan

    Toru Kono

  4. Inflammatory Bowel Disease Center, Higashi-Tokushukai Hospital, Sapporo, Hokkaido, Japan

    Toru Kono

Authors
  1. Alessandro Fichera
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  2. Marco Zoccali
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  3. Toru Kono
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Correspondence to Alessandro Fichera.

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Fichera, A., Zoccali, M. & Kono, T. Antimesenteric Functional End-to-End Handsewn (Kono-S) Anastomosis. J Gastrointest Surg 16, 1412–1416 (2012). https://doi.org/10.1007/s11605-012-1905-7

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  • DOI: https://doi.org/10.1007/s11605-012-1905-7

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