P275 Anastomotic technique drives endoscopic recurrence in Postoperative Crohn's Disease: a systematic review and meta-analysis

Nardone, O.M.(1,2)*;Luglio, G.(3);Calabrese, G.(4);Giglio, M.(5);Castiglione, F.(4);Ghosh, S.(6);Iacucci, M.(1,6);

(1)University of Birmingham, Institute of Immunology and Immunotherapy, Birmingham, United Kingdom;(2)University Federico II of Naples, Gastroenterology- Department of Public Health, Naples, Italy;(3)University Federico II of Naples, Endoscopic Surgery Unit- Department of Public Health, Naples, Italy;(4)University Federico II of Naples, Gastroenterology- Department of Clinical Medicine and Surgery, Naples, Italy;(5)University Federico II of Naples, Division of Hepato-biliary-pancreatic- Minimally Invasive and Robotic surgery- Department of Clinical Medicine and Surgery, Naples, Italy;(6)University College Cork, APC Microbiome Ireland- College of Medicine and Health, Cork, Ireland;


Patients with Crohn's disease (CD) after Ileo-colic resection may develop an endoscopic postoperative recurrence (ePOR) that reaches approximately 70% of incidence within six months. ECCO guidelines favour a stapled side-to-side anastomosis. However, the advent of the Kono-S ileocolic anastomosis, a hand-sewn antimesenteric functional end-to-end anastomosis, seems to reduce clinical risk and ePOR. Whilst the majority of the studies have assessed the rate of ePOR individually, currently there is limited data comparing surgical techniques of the anastomosis. Hence, we aimed to assess the impact of different surgical techniques on ePOR in CD


We searched PubMed and Embase in October 2022 for eligible studies reporting the surgical types of anastomosis and, based on these, the rate of endoscopic recurrence at a minimum of six months. Studies were grouped by conventional anastomosis vs Kono, and comparisons were made between these groups. Pooled incidence rates of ePOR were computed using random-effect modelling. Meta-regression and subgroup analyses were performed to examine the impact of the type of anastomosis on the incidence of ePOR ≥ 6 months


Thirteen studies, including 1816 patients who underwent ileocolic resection for CD, were included. Among these patients, 282 (15.5%) received a Kono-S anastomosis, while 1534 (84.4%) had a conventional anastomosis. ePOR at ≥≥ six months showed a pooled incidence of 31.8% (95% CI, 24.8 to 39.2), with significant heterogeneity among the studies (p<0.01). Meta-regression analysis showed that Kono-S anastomosis was associated with a significant reduction in the ePOR at endoscopic follow-up (p=0.001). In detail, patients receiving a Kono-S anastomosis had a pooled incidence of ePOR of 12% (95% CI, 3.1 to 24.9), while patients receiving a conventional anastomosis had an ePOR of 38.2 (95% CI, 30 to 46.9%) [Figure1].

Funnel plot asymmetry [Figure 2] and Egger's regression test (p=0.118) indicated the absence of a publication bias                                                                                                    


Kono-S anastomosis was associated with a significant reduction of ePOR at ≥ six months compared to the conventional anastomosis. Our findings highlight the need to standardize and implement the use of Kono-S anastomosis, particularly for difficult-to-treat patients with high risk for a post-operative recurrence