Postoperative efficacy study of modified anti-mesenteric functional end-to-end anastomosis on Crohn's disease
10.3760/cma.j.cn101480-20230707-00097
- VernacularTitle:克罗恩病行改良对系膜缘功能性端端吻合术的疗效研究
- Author:
Ming DUAN
1
;
Yi LI
1
;
Lei CAO
1
;
Dengyu FENG
1
;
Jianfeng GONG
1
;
Weiming ZHU
1
Author Information
1. 南京大学医学院附属金陵医院（东部战区总医院）普通外科，南京 210002
- Publication Type:Journal Article
- Keywords:
Crohn′s disease;
Anti-mesenteric functional end-to-end anastomosis, modified;
Postoperative complications;
Endoscopic recurrence
- From:
Chinese Journal of Inflammatory Bowel Diseases
2024;08(3):193-199
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the efficacy of modified anti-mesenteric functional end-to-end anastomosis (Kono-S) on Crohn's disease (CD) .Methods:A retrospective cohort study was conducted. Clinical data of CD patients who underwent modified Kono-S surgery at Jinling Hospital of Medical School of Nanjing University from January 2020 to April 2023 were collected. Primary endpoint was postoperative endoscopic recurrence rate. Secondary endpoints were postoperative complication rate within 30 days, postoperative clinical recurrence rate, and factors influencing endoscopic recurrence. Endoscopic recurrence was defined as Rutgeerts score of i2b or higher at the anastomotic stomas. Clinical recurrence was defined as Crohn's disease activity index (CDAI) >150 points based on the endoscopic recurrence. Patients were divided into recurrence and non-recurrence groups according to the endoscopic recurrence, and univariate analysis and multivariate Logistic regression analysis were used to identify factors of endoscopic recurrence.Results:A total of 75 CD patients [46 men, 29 women; mean age, (38.5 ± 14.1) years; mean CDAI score, (71.8 ± 22.6) points] were included. Sixty patients underwent partial small bowel resection, 6 underwent ileocecal resection, 6 underwent right hemicolectomy, and 3 underwent subtotal colectomy. The operation time was (116 ± 27) minutes, and the time of the modified Kono-S anastomosis construction was (24 ± 4) minutes. Incidence rate of Clavien-Dindo grade Ⅱ or higher complications was 12% (9/75) within 30 days postoperatively, with no intra-abdominal infectious complication and death. During the follow-up period of 15 (6, 23) months, 39 patients underwent endoscopic examination, and the endoscopic recurrence rate was 20.5% (8/39) and clinical recurrence rate was 2.6% (1/39) . Male was identified as the independent risk factor for endoscopic recurrence ( OR = 18.7, 95% CI: 1.7-200.8, P = 0.02) . Conclusion:Modified Kono-S is a safe and convenient treatment for CD with a low risk of anastomotic endoscopic recurrence, however, male patients are more prone to the recurrence.
