OP16 Postoperative endoscopic recurrence after ileocecal resection for Crohn’s disease with Kono-S or side-to-side functional end anastomosis:12-18 months follow-up results from a Multicenter Prospective Randomized Trial
Authors: Trencheva K , Kienle P , Luglio G , D’Hoore A , Spinelli A , Flemming S , Scaringi S , Malinka S , Christos P , Tropeano F , Bislenghi G , Michelassi F 
Published: January 2025

Abstract

Background
Previous studies have suggested that a novel anastomosis (Kono-S) is associated with lower endoscopic and surgical recurrence rates after ileocecal resection for Crohn’s disease (CD)[1-3]. This study aims to compare the endoscopic recurrence between the Kono-S and side-to-side functional end anastomosis at 12-18 months after ileocecal resection for CD.

Methods
Prospective randomized trial conducted at 8 international centers. Patients undergoing ileocecal resection were randomized to a Kono-S(Group 1) or a side-to-side functional end (Group 2) anastomosis and were discharged on no biologicals. Exclusion criteria included age (&lt;18), pregnancy, recurrent or multisite CD, and need of postoperative treatment with biologicals. Data were collected prior to and during surgery, daily after surgery until discharge, at 30 days post-op, and during colonoscopy at 12-18 months(m). Biologic therapy was allowed after the first colonoscopy at 3-6 m. Participating surgeons were instructed in the Kono-S technique through videos. Disease clinical activity was measured by the Harvey-Bradshaw Index (HBI). Endoscopic remission/recurrence was graded with the modified Rutgeerts score, and all sites used the same endoscopic evaluation protocol (Image1). Endoscopic remission was defined as a Rutgeerts score of 0,1 or 2a, and a Rutgeerts score of 2b or higher was considered a recurrence. All study sites had Institutional Review Board approval, ClinicalTrial.gov #NCT03256240.

Results
We enrolled 366 CD patients (50.0% female) with a median age of 35(18-81). 192 patients were randomized to Group 1(Kono-S) and 174 to Group 2(Side-to-Side). 255 patients (70%) completed 12-18m follow-up. Group 1 had a higher incidence of past smokers (87 vs.54, p=0.005) and current smokers (56 vs.27, p=0.002). 216(59%) patients underwent 12-18m colonoscopy, and 70/216(32.4%) had endoscopic recurrence (36/114,31.6% in Group 1 and 34/102,33.3% in Group 2, p=0.884). 106/216(49.1%) had been started on biological therapy after the first colonoscopy at 3-6 months. Subgroup analyses for endoscopic recurrence at 12-18m showed no significant difference between the groups (with biologicals p=0.539; without biologicals p=0.684). There was no difference in recurrence rate based on biologicals irrespective of anastomosis type. Stricturing (B2), fistulating disease (B3), and HBI moderate disease activity before surgery were predictive for 12-18m endoscopic recurrence with odds respectively of OR=4.20,[1.19-19.46], p=0.028, OR=5.35,[1.45-19.69], p=0.012, and OR=3.29,[1.26-8.60], p=0.015.

Conclusion
Kono-S and Side-to-Side anastomoses have similar endoscopic recurrence rates at 12-18 months. CD type and clinical disease activity are predictors of recurrence.

References
1.Kono T, Ashida T, Ebisawa Y, Chisato N, Okamoto K, Katsuno H, Maeda K, Fujiya M, Kohgo Y, Furukawa H. A new antimesenteric functional end-to-end handsewn anastomosis: surgical prevention of anastomotic recurrence in Crohn's disease. Diseases of the colon & rectum. 2011;54(5):586-592.
2.Kono T, Fichera A, Maeda K, Sakai Y, Ohge H, Krane M, Katsuno H, Fujiya M. Kono-S anastomosis for surgical prophylaxis of anastomotic recurrence in Crohn's disease: an international multicenter study. Journal of Gastrointestinal Surgery. 2016;20(4):783-790.
3.Kono T, Fichera A. Surgical Prophylaxis of Crohn's Disease Recurrence. Annals of Surgery. 2020; 272 (2): 218-219. doi: 10.1097/SLA.0000000000003936.