P0650 Comparative study between Kono-S and latero-lateral isoperistaltic anastomosis in the treatment of terminal ileum Crohn’s Disease patients: perioperative complications and short-term results
Authors: Colombo F , Gatti F , Lazzarino M , Guerci C , Gridavilla D , Maconi G , Danelli P 
Published: January 2025

Abstract

Background
The main challenge in surgical treatment for terminal ileal Crohn’s Disease is represented by the significant recurrence at the anastomotic site after ileocecal resection.1 Latero-lateral anastomosis is frequently performed in this kind of surgery because of its characteristics of ductility and reproducibility; the Kono-S anastomosis - characterized by a supporting structure and a wider lumen - was recently introduced to reduce the risk of recurrence.2 Several studies indicate a reduction in recurrence and complications, but evidence remains limited and controversial, particularly for long-term follow-up.3, 4

Methods
This monocentric study included 30 Crohn’s patients admitted in a Tertiary Care IBD Centre in Milan between 2023 and 2024, comparing 10 patients who underwent Kono-S anastomosis with 20 who underwent latero-lateral isoperistaltic anastomosis.
Both groups included patients with ileal stenosing Crohn’s Disease (B2-L1 according to the Montreal classification). Surgery was performed with a mini-invasive approach, and the selected patients were naïve to abdominal surgery for Crohn’s.

Results
Preoperative variables considered included the mean age of the patients, BMI, sex, smoking habit, Charlson Comorbidity Index (CCI), ASA score, duration of illness at the time of surgery.
Regarding postoperative data, blood glucose showed significantly higher mean values in the Kono-S group (125.1 ± 26.3 mg/dL) than in the latero-lateral group (105.7 ± 20.1 mg/dL). About postoperative complications, our data shows that one patient in the Kono-S group developed perianastomotic abscess, one other needed blood transfusion for anaemia and one patient underwent reintervention for anastomotic bleeding (Clavien-Dindo 3b). In the latero-lateral group, two patients developed anaemia (without needing blood transfusion) and other two needed blood transfusion; finally, one patient developed anastomotic leak requiring reintervention. The mortality was nil.
Other postoperative data (such as duration of surgery, C-Reactive Protein in 1 and 3 postoperative days, number of days before gas flatus and stool canalization, fever, assumption of diet, number of days before discharge, re-admission and re-intervention) were analysed (reported in the attached table).

Conclusion
Our results indicate an overlap between the two techniques in terms of safety and perioperative management, with a comparable rate of major complications such as anastomotic dehiscence (0% in the Kono-S group versus 5% in the latero-lateral group) or readmission. However, the small sample size limits the scope of the results and suggests the need for further studies to assess the actual impact of the Kono-S technique on long-term recurrence.

References
1.Nos P, Domenech E. Postoperative Crohn’s disease recurrence: a practical approach. World J Gastroenterol 2008;14(36):5540–5548.
2.Kono T, Fichera A, Maeda K, et al. Kono-S anastomosis for surgical prophylaxis of anastomotic recurrence in Crohn’s disease: an International Multicenter Study. J Gastrointest Surg 2016;20 (04):783–790.
3.Alshantti A, Hind D, Hancock L, Brown SR. The role of Kono-S anastomosis and mesenteric resection in reducing recurrence after surgery for Crohn’s disease: a systematic review. Colorectal Dis. 2021 Jan;23(1):7-17.
4.Baloyiannis I, Perivoliotis K, Sarakatsianou C, Chatzinikolaou C, Tzovaras G. The Reduction of Anastomosis-Related Morbidity Using the Kono-S Anastomosis in Patients with Crohn’s Disease: A Meta-Analysis. J Clin Med. 2024 Apr 23;13(9):2461.