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Kono-S anastomosis for Crohn’s disease: a systemic review, meta-analysis, and meta-regression

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Abstract

The Kono-S anastomosis was introduced in 2011 as an alternative anastomosis in Crohn’s disease (CD) surgery. Since then, prevailing evidence of the favorable results of the Kono-S anastomosis has been published from around the world. We conducted this study to analyze the effectiveness of the Kono-S anastomosis, by searching Medline, Embase, CNKI, and google scholar. Binominal data were analyzed after Freeman–Tukey double-arcsine transformation. Comparative data were analyzed using the Mantel–Haenszel model for dichotomous outcomes and the mean difference for continuous outcomes. We identified 676 patients who underwent surgery with a Kono-S anastomosis. Surgical recurrence was pooled at an average of 0% (CI: 0.00–0.01) and a reduced mean Rutgeerts score of 1.375 (CI: 0.727–2.023) after Kono-S anastomosis. Endoscopic recurrence after sensitivity analysis was 5% (CI: 0.00–0.15). Complications were rare, with a 3% incidence of ileus (CI: 0.01–0.05), a 4% incidence of small bowel obstruction (CI: 0.01–0.10), a 1% incidence of an anastomotic leak incidence (CI: 0.00–0.03), and a 10% incidence of postoperative infection (CI: 0.03–0.20). Evidence from this meta-analysis favors the Kono-S anastomosis for CD patients, especially for ileocolic anastomosis. Thus, clinicians should consider the applicability of Kono-S anastomosis in respective institutions.

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Author notes

  1. Cheng Han Ng and Yip Han Chin equal contribution.

Authors and Affiliations

  1. Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore

    Cheng Han Ng, Yip Han Chin, Snow Yunni Lin, Bettina Lieske & Choon Seng Chong

  2. Department of Pharmacy, National University Singapore, Singapore, Singapore

    Jeffery Wei Heng Koh

  3. Division of Colorectal Surgery, Department of Surgery, National University Hospital, Singapore, Singapore

    Bettina Lieske & Choon Seng Chong

  4. Department of General Surgery, Sengkang General Hospital, Singapore, Singapore

    Frederick Hong-Xiang Koh & Fung Joon Foo

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Ng, C.H., Chin, Y.H., Lin, S.Y. et al. Kono-S anastomosis for Crohn’s disease: a systemic review, meta-analysis, and meta-regression. Surg Today 51, 493–501 (2021). https://doi.org/10.1007/s00595-020-02130-3

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