title: Novel antimesenteric functional end-to-end handsewn (Kono-S) anastomoses for Crohn's disease: a report of surgical procedure and short-term outcomes.
abstract: BACKGROUND
  Anastomotic surgical recurrence after bowel resection is a major problem in patients with Crohn's disease. The aim of this prospective observational study was to evaluate the efficacy of a novel technique for restoring bowel continuity after resection involving either the small or the large intestine.
  
  
  METHODS
  The first case was instructed by Dr. Kono at Fujita Health University. The involved bowel segment was divided transversely with a linear stapler. The edges of two stapled lines are then connected to create a supporting column, which prevented surgical recurrence from anastomotic distortion due to mesenteric longitudinal ulcers. Thereafter, an antimesenteric longitudinal enterotomy was performed on each side to create a large-sized handsewn end-to-end anastomosis.
  
  
  RESULTS
  Thirty consecutive patients underwent Kono-S anastomoses from December 2009 to August 2013. Neither anastomotic leakage nor surgical recurrence was observed during a median follow-up period of 35 months. Endoscopic surveillance was performed in 18 cases (69.2%) undergoing ileo-colonic or ileo-rectal anastomosis with an average Rutgeert's score of 0.78 (0-3) at a mean of 14.5 months postoperatively.
  
  
  CONCLUSIONS
  The Kono-S anastomosis for Crohn's disease has been a safe and feasible technique. Long-term outcomes are required to confirm its advantage in preventing surgical recurrence at the anastomosis.
authors: Department of Surgery, Fujita Health University, Toyoake, Japan.
authors: Hidetoshi
authors: H
authors: Katsuno
authors: Koutarou
authors: K
authors: Maeda
authors: Tsunekazu
authors: T
authors: Hanai
authors: Koji
authors: K
authors: Masumori
authors: Yoshikazu
authors: Y
authors: Koide
authors: Toru
authors: T
authors: Kono
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods*; D003424:Crohn Disease / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007422:Intestines / Q000601:surgery*; D008297:Male; D008643:Mesentery / Q000601:surgery; D008875:Middle Aged; D011446:Prospective Studies; D017792:Surgical Stapling; D016896:Treatment Outcome; D055815:Young Adult