title: A new antimesenteric functional end-to-end handsewn anastomosis: surgical prevention of anastomotic recurrence in Crohn's disease.
abstract: BACKGROUND
  Recurrence of Crohn's disease usually occurs at anastomotic sites.
  
  
  OBJECTIVE
  A new anastomosis technique (Kono-S anastomosis) designed to minimize anastomotic restenosis was compared with conventional anastomoses.
  
  
  METHODS
  The Kono-S anastomosis technique was first used for Crohn's disease in 2003 at the Asahikawa Medical University Hospital. The resection is accomplished by transecting the bowel with a linear cutter so that the mesentery side is located in the center of the stump. Both stumps are sutured to create a supporting column to maintain the diameter and dimension of the anastomosis. Longitudinal enterotomies are made at the antimesenteric sides of the 2 segments of intestine. The side-to-side antimesenteric anastomosis is then performed in transverse fashion. The medical records and follow-up details of all patients undergoing this procedure were reviewed.
  
  
  METHODS
  : From 2003 to 2009, 69 patients with Crohn's disease who underwent Kono-S anastomosis (group S) were compared with 73 historical patients with Crohn's disease who underwent conventional anastomosis (group C) from 1993 to 2003.
  
  
  METHODS
  A Kaplan-Meier analysis of the follow-up data on surgical recurrence at the anastomosis was performed. The endoscopic recurrence score at the anastomosis was calculated.
  
  
  RESULTS
  The median endoscopic recurrence score in group S was significantly lower than that in group C (2.6 vs 3.4; P = .008). The Kaplan-Meier analysis showed a lesser probability of anastomotic surgical recurrence in the S group at 5 years (0% vs 15%; P = .0013). The absence of postoperative infliximab did not affect the restenosis rate in group S.
  
  
  CONCLUSIONS
  This study was limited by its historical retrospective nature.
  
  
  CONCLUSIONS
  The Kono-S anastomosis appears to be effective in preventing anastomotic surgical recurrence in Crohn's disease.
authors.affiliation: Division of Gastroenterologic and General Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan. kono@asahikawa-med.ac.jp
authors.forename: Toru
authors.initials: T
authors.lastname: Kono
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Ashida
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ebisawa
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Chisato
authors.forename: Kotaro
authors.initials: K
authors.lastname: Okamoto
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Katsuno
authors.forename: Kotaro
authors.initials: K
authors.lastname: Maeda
authors.forename: Mikihiro
authors.initials: M
authors.lastname: Fujiya
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kohgo
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Furukawa
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D003106:Colon / Q000601:surgery*; D003424:Crohn Disease / Q000175:diagnosis / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055502:Secondary Prevention; D013536:Suture Techniques; D016896:Treatment Outcome; D055815:Young Adult