Evidence map›Paper›PMID 39289220›Full record

SynthesisTechniques in coloproctology2024

Effect of Kono-S anastomosis on reducing postoperative recurrence rates in Crohn's disease: a systematic review and meta-analysis.

W Lin, M Lemke, A Ghuman, P T Phang, C J Brown, M J Raval, E A Clement, A A Karimuddin

Abstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Techniques in coloproctology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Review
  5. Article
  6. Article
  7. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

W LinColorectal Surgery Division, Department of Surgery, St Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada. wlin5@providencehealth.bc.ca.
M LemkeDepartment of Surgery, Western University, London, ON, Canada.
A GhumanColorectal Surgery Division, Department of Surgery, St Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
P T PhangColorectal Surgery Division, Department of Surgery, St Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
C J BrownColorectal Surgery Division, Department of Surgery, St Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
M J RavalColorectal Surgery Division, Department of Surgery, St Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
E A ClementColorectal Surgery Division, Department of Surgery, St Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
A A KarimuddinColorectal Surgery Division, Department of Surgery, St Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundKono-S anastomosis has gained increasing interest although evaluation of its impact on reducing Crohn's recurrence shows conflicting results. This study aimed to evaluate the short- and long-term outcomes for patients with Crohn's disease requiring surgery with Kono-S compared to conventional anastomosis.

methodsA systematic review and meta-analysis included patients with Crohn's disease treated with bowel resection and Kono-S anastomosis reconstruction versus a comparator arm of conventional anastomosis technique. Recurrence outcomes examined were endoscopic recurrence rates, mean postoperative Rutgeerts score, surgical recurrence, clinical recurrence, and postoperative biologics use. Short-term postoperative outcomes include anastomotic leaks, surgical site infection, postoperative ileus, and mean operative time.

resultsA total of 873 studies were identified with 15 remaining after abstract review encompassing 1501 patients, 765 with Kono-S and 736 with conventional anastomosis. Recurrence was significantly lower in the Kono-S arm, with endoscopic recurrence rates of 41% vs 48% (RR 0.86, 95% CI 0.73-1.00, p = 0.05) and surgical recurrence rates of 2.7% vs 21.0% (RR 0.13, 95% CI 0.06-0.30, p < 0.001). There was a significantly lower anastomotic leak rate in the Kono-S arm when compared to conventional anastomosis, 1.7% vs 4.9% (RR 0.37, 95% CI 0.19-0.74, p = 0.005). Mean operative time was similar between both groups.

conclusionsKono-S is a safe and feasible anastomotic technique with lower rates of endoscopic and surgical postoperative recurrence. While we await further trials to substantiate this benefit, Kono-S anastomosis should be considered as an important tool in the armamentarium of a surgeon in anastomotic construction to reduce recurrence.

Indexed as

Anastomosis, SurgicalCrohn DiseaseRecurrenceAnastomotic LeakColonHumansOperative TimePostoperative ComplicationsSecondary PreventionTreatment OutcomeCrohn’s diseaseEndoscopic recurrenceInflammatory bowel diseaseKono-S anastomosisPost operative recurrence

Identifiers

PMID39289220

What OpenQuestion holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.