Journal Review in Colorectal Surgery: Kono-S Anastomosis and Stem Cells in Crohn’s Disease

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 15 September 2022

⏱️ 35 minutes

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Summary

You are faced with a young patient with ileal Crohn’s disease. He requires an ileocolic resection. Which type of anastomosis do you perform? You also see another patient with complex perianal fistulas and the patient asks about the safety and efficacy of stem cells for fistula closure. What do you tell the patient?

Join Dr. Carole Richard, Dr. François Dagbert and Dr. Maher Al Khaldi in their conversation about the Kono-S anastomosis after ileocolic resections and stem cell therapy for perianal complex fistulas for Crohn’s disease.

Learning objectives
- To understand the rationale for the Kono-S anastomosis and the way it is fashioned.
- To explain the possible advantages of the Kono-S anastomosis following ileocolic resection.
- To explain the possible advantages of stem cell therapy for complex perianal fistulas.
- To understand which patient population might be eligible for future stem cell therapy for complex perianal fistulas.

References
In order throughout the episode:
Article 1: Luglio G, Rispo A, Imperatore N, Giglio MC, Amendola A, Tropeano FP, Peltrini R, Castiglione F, De Palma GD, Bucci L. Surgical Prevention of Anastomotic Recurrence by Excluding Mesentery in Crohn's Disease: The SuPREMe-CD Study - A Randomized Clinical Trial. Ann Surg. 2020 Aug;272(2):210-217. doi: 10.1097/SLA.0000000000003821. PMID: 32675483.

Article 2: Panés J, García-Olmo D, Van Assche G, Colombel JF, Reinisch W, Baumgart DC, Dignass A, Nachury M, Ferrante M, Kazemi-Shirazi L, Grimaud JC, de la Portilla F, Goldin E, Richard MP, Leselbaum A, Danese S; ADMIRE CD Study Group Collaborators. Expanded allogeneic adipose-derived mesenchymal stem cells (Cx601) for complex perianal fistulas in Crohn's disease: a phase 3 randomised, double-blind controlled trial. Lancet. 2016 Sep 24;388(10051):1281-90. doi: 10.1016/S0140-6736(16)31203-X. Epub 2016 Jul 29. PMID: 27477896.

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Transcript

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0:00.0	Behind the Night, the surgery podcast, relevant and engaging content designed to help you dominate the day.
0:13.0	Hello to all. Hope your summer brought you sunshine and energy. In Canada, we had a fabulous
0:29.0	month of August. So here we are again, Dr. François Dachbaire, our super keen PGY for
0:38.0	Mahal Aykadi and myself, Karadri Shah, for an episode of a journal club. We chose to focus today on
0:50.0	IBD, more specifically Crohn's disease. We will be presenting two articles on two different Crohn's
1:01.0	disease subjects. The first article will be focusing on the popular Kono-S anastomosis and the second
1:10.0	one will focus on the treatment of complex perianing fistulas using stem cells. Let's jump into
1:19.0	the first article. So François? Yeah, so the first article we will discuss was led by Dr.
1:28.0	Luglio, as first author and professor, Bootsie, as a senior author. And his entitled,
1:34.0	Surgical Prevention of Anastomotic Records by excluding mezzanterie and Crohn's disease, the
1:40.0	Supreme CD study, a randomized control trial. It was published in 2020 in the Annals of Surgery.
1:47.0	The background of this study is basically a trial that aimed to provide a randomized control
1:53.0	data comparing Kono-S anastomosis and staple illiocolic site to site anastomosis.
2:00.0	It was performed in a single tertiary referral center in Italy.
2:05.0	Okay, so François, why is it important to talk about the way an anastomosis is fashioned
2:13.0	in resections for Crohn's disease? Well, we know that a high percentage of Crohn's disease
2:20.0	patient will require surgical treatment at some point in their lives. It is also known that
2:25.0	surgery improve quality of life but is not curative, and one of the major post-operative
2:30.0	concern is an anastomotic recurrence, which is specifically a problem following an
2:36.0	illiocolic resection. Multiple risk factors for recurrence are quite established,
2:42.0	like smoking habits, age, and onset of disease, behavior of disease according to the
2:48.0	Montreal classification, and the presence of parianol disease, as well as requirement for
	...

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