Abstract

Safety & feasibility of targeted mesenteric approaches with Kono-S anastomosis and extended mesenteric excision in ileocolic resection and anastomosis in Crohn's disease

Am J Surg. 2024 Apr:230:16-20. doi: 10.1016/j.amjsurg.2023.10.050. Epub 2023 Oct 26.

 

Stefan D Holubar 1Jeremy Lipman 2Scott R Steele 2Tairin Uchino 2Eddy P Lincango 2David Liska 2Kristen Ban 2David Rosen 2Joshua Sommovilla 2Emre Gorgun 2Hermann Kessler 2Michael Valente 2Tracy Hull 2

 
     

Author information

1Dept. of Colorectal Surgery, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address: holubas@ccf.org.

2Dept. of Colorectal Surgery, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH, USA.

Abstract

Background: The mesentery has recently been implicated in the pathophysiology of Crohn's disease (CD), and several techniques have been developed to target the mesentery to reduce its influence on recurrence. We aimed to describe short-term safety and feasibility after these approaches.

Methods: This is a comparative, retrospective, single-center cohort study of consecutive CD patients undergoing primary or redo ileocolic resection from 2015 to 2022 with Kono-S anastomosis (KSA), extended mesenteric excision (EME) only, or both: mesenteric excision and exclusion (MEE).

Results: 186 patients underwent KSA (n ?= ?74), EME (n ?= ?66), or MEE (n ?= ?46). The groups had comparable baseline characteristics. The MEE group operative time was longer (median: 187 vs. KSA 170, EME 152 ?min, p ?< ?0.01). Postoperatively, the groups had similar lengths of stay (median 4 days), readmissions (9.1 ?%), major postoperative complications (6.5 ?%), and anastomotic leaks (1.1 ?%).

Conclusion: Targeting the mesentery with novel surgical approaches for ileocolic Crohn's disease was safe and feasible for short-term follow-up.

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