演題

Short-term outcomes of novel anastomotic technique for Crohn’s disease

[演者] 勝野 秀稔:1
[著者] 前田 耕太郎:1, 花井 恒一:1, 佐藤 美信:1, 升森 宏次:1, 小出 欣和:1, 松岡 宏:1, 塩田 規帆:1, 尾関 伸司:1, 八田 浩平:1, 水野 真広:1, 鄭 栄哲:1, 遠山 邦宏:1, 河野 透:2
1:藤田保健衛生大学下部消化管外科, 2:札幌東徳州会病院外科

Introduction: Surgical anastomotic recurrence is a major complication during follow-up period in patients with Crohn's disease. Despite the improvement of monoclonal antibody therapy, the rate of anastomotic recurrence still remains high. We introduced a novel antimesenteric functional end-to end hand-sewn (Kono-S) anastomosis to prevent surgical recurrence. Methods: The affected bowel is resected transversely with a linear stapler on both sides. The both stapled lines are then sutured together to create the robust supporting column. An antimesenteric longitudinal enterotomy is performed from 0.5-1cm away from the staple line, to allow a 7-8cm transverse lumen. Finally, the large-size flask-shaped antimesenteric hand-sewn anastomosis was completed with Gambee suture. Results: A total of 32 Kono-S anastomoses have been performed since 2009 in 30 patients with a mean age of 34-year-old. Twelve patients had undergone the previous surgeries for Crohn's disease. Mean operative time was 199 minutes (110-329) and estimated blood loss was 153ml (5-1100). Postoperative ileus was observed in one patient and treated conservatively. No surgical recurrence was diagnosed during the median follow-up years. A total of 18 patients have been evaluated the anastomoses with colonoscopy. The average Rutgeerts score was 0.73(0-3). Conclusion: The Kono-S anastomosis is a safe and feasible procedure for Crohn's disease. Long-term follow-up is required to confirm its efficacy in preventing anastomotic recurrence.
詳細検索
アプリバナー iPhone版,iPad版 Android版