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Meta-Analysis
. 2024 Jul 22;409(1):227.
doi: 10.1007/s00423-024-03412-x.

Safety and effectivity of Kono-S anastomosis in Crohn's patients: a systematic review and Meta-analysis

Marionna Cathomas #  1 , Baraa Saad #  2 , Stephanie Taha-Mehlitz  3 , Dilip K Vankayalapati  4 , Nour El Ghazal  2 , Mohammed Majd Mourad  2 , Niklas Ortlieb  5 , Christian A Than  6 , Emanuel Burri  7 , Christine Glaser  1 , Andres Heigl  1 , Katerina Neumann  8 , Michael D Honaker  9 , Anas Taha #  10   11   12 , Robert Rosenberg #  1
Affiliations
Meta-Analysis

Safety and effectivity of Kono-S anastomosis in Crohn's patients: a systematic review and Meta-analysis

Marionna Cathomas et al. Langenbecks Arch Surg. .

Abstract

Purpose: Kono-S anastomosis, an antimesenteric, functional, end-to-end handsewn anastomosis, was introduced in 2011. The aim of this meta-analysis is to evaluate the safety and effectivity of the Kono-S technique.

Methods: A comprehensive search of MEDLINE (PubMed), Embase (Elsevier), Scopus (Elsevier), and Cochrane Central (Ovid) from inception to August 24th, 2023, was conducted. Studies reporting outcomes of adults with Crohn's disease undergoing ileocolic resection with subsequent Kono-S anastomosis were included. PRISMA and Cochrane guidelines were used to screen, extract and synthesize data. Primary outcomes assessed were endoscopic, surgical and clinical recurrence rates, as well as complication rates. Data were pooled using random-effects models, and heterogeneity was assessed with I² statistics. ROBINS-I and ROB2 tools were used for quality assessment.

Results: 12 studies involving 820 patients met the eligibility criteria. A pooled mean follow-up time of 22.8 months (95% CI: 15.8, 29.9; I2 = 99.8%) was completed in 98.3% of patients. Pooled endoscopic recurrence was reported in 24.1% of patients (95% CI: 9.4, 49.3; I2 = 93.43%), pooled surgical recurrence in 3.9% of patients (95% CI: 2.2, 6.9; I2 = 25.97%), and pooled clinical recurrence in 26.8% of patients (95% CI: 14, 45.1; I2 = 84.87%). The pooled complication rate was 33.7%. The most common complications were infection (11.5%) and ileus (10.9%). Pooled anastomosis leakage rate was 2.9%.

Conclusions: Despite limited and heterogenous data, patients undergoing Kono-S anastomosis had low rates of surgical recurrence and anastomotic leakage with moderate rates of endoscopic recurrence, clinical recurrence and complications rate.

Keywords: Bowel resection; Crohn’s disease; Functional end to end anastomosis; Kono-S anastomosis.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Forest plots of recurrence. A) Pooled rate of Clinical Recurrence B) Pooled rate of Surgical Recurrence C) Pooled rate of Endoscopic Recurrence D) Pooled mean Rutgeert Score
Fig. 2
Fig. 2
Forest plots of complications, anastomosis leakage and reintervention. A) Pooled rate of Anastomosis Leakage B) Pooled rate of Reintervention C) Pooled rate of Infection D) Pooled rate of Ileus E) Pooled total Rate of Complications
See this image and copyright information in PMC

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