Norimitsu Shimada1, Hiroki Ohge2, Toru Kono3, Ayumu Sugitani3, Raita Yano2, Yusuke Watadani2, Kenichiro Uemura2, Yoshiaki Murakami2, Taijiro Sueda2. 1. Department of Surgery, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, Japan. shimada@hiroshima-u.ac.jp. 2. Department of Surgery, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, Japan. 3. Center for Clinical and Biomedical Research, Sapporo Higashi Tokushukai Hospital, 3-1, Kita 33-jo Higashi, 14-chome, Higashi-ku, Sapporo, Hokkaido, 065-0033, Japan.
Abstract
BACKGROUND: Anastomotic surgical recurrence after bowel resection in Crohn's disease patients is problematic. This study was performed to evaluate the increased risk of anastomotic surgical recurrence. METHODS: From 2006 to 2016, we performed anastomoses in 215 consecutive Crohn's disease patients. The cohort was divided into two groups: Kono-S anastomosis (n = 117) and end-to-end anastomosis (n = 98). Multivariate analysis of predictors of anastomotic surgical recurrence and Kaplan-Meier analysis for the 5-year anastomotic surgical recurrence rate were evaluated. RESULTS: The two groups showed no statistically significant differences in patient backgrounds. During a median follow-up of 54 months, 28 patients required anastomotic surgical recurrence [4 (3.4%) in the Kono-S group and 24 (24.4%) in the end-to-end group]. Six leaks (5.1%) were detected in the Kono-S group and 17 leaks (17.3%) in the end-to-end group; all were successfully treated conservatively. End-to-end anastomosis, leakage, age < 45 years, and body mass index of ≥ 18 kg/m2 at the first surgery had a higher risk of anastomotic surgical recurrence. Kono-S anastomosis significantly reduced the risk of anastomotic surgical recurrence after 1 year (odds ratio, 0.14). Anastomotic leakage influenced anastomotic surgical recurrence within 1 year (odds ratio, 4.84). The 5-year surgery-free survival rate at the anastomosis site with Kono-S anastomosis (95.0%) was significantly higher than that with end-to-end anastomosis (81.3%; P < 0.001). CONCLUSIONS: Anastomotic leakage after bowel resection in Crohn's disease patients increased anastomotic surgical recurrence within 1 year, and Kono-S anastomosis is associated with a low risk of anastomotic surgical recurrence after > 1 year.
BACKGROUND: Anastomotic surgical recurrence after bowel resection in Crohn's diseasepatients is problematic. This study was performed to evaluate the increased risk of anastomotic surgical recurrence. METHODS: From 2006 to 2016, we performed anastomoses in 215 consecutive Crohn's diseasepatients. The cohort was divided into two groups: Kono-Sanastomosis (n = 117) and end-to-end anastomosis (n = 98). Multivariate analysis of predictors of anastomotic surgical recurrence and Kaplan-Meier analysis for the 5-year anastomotic surgical recurrence rate were evaluated. RESULTS: The two groups showed no statistically significant differences in patient backgrounds. During a median follow-up of 54 months, 28 patients required anastomotic surgical recurrence [4 (3.4%) in the Kono-S group and 24 (24.4%) in the end-to-end group]. Six leaks (5.1%) were detected in the Kono-S group and 17 leaks (17.3%) in the end-to-end group; all were successfully treated conservatively. End-to-end anastomosis, leakage, age < 45 years, and body mass index of ≥ 18 kg/m2 at the first surgery had a higher risk of anastomotic surgical recurrence. Kono-Sanastomosis significantly reduced the risk of anastomotic surgical recurrence after 1 year (odds ratio, 0.14). Anastomotic leakage influenced anastomotic surgical recurrence within 1 year (odds ratio, 4.84). The 5-year surgery-free survival rate at the anastomosis site with Kono-Sanastomosis (95.0%) was significantly higher than that with end-to-end anastomosis (81.3%; P < 0.001). CONCLUSIONS:Anastomotic leakage after bowel resection in Crohn's diseasepatients increased anastomotic surgical recurrence within 1 year, and Kono-Sanastomosis is associated with a low risk of anastomotic surgical recurrence after > 1 year.
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