In this video, we demonstrate two operative techniques used to reduce the risk of anastomotic recurrence in Crohn’s disease.
It has been suggested that the mesentery is a pathological driver of disease recurrence in Crohn’s and performing a radical mesenteric excision has shown promising results in reducing rates of anastomotic recurrence [1, 2]. The first section of the video demonstrates a standardised technique to perform a radical mesenteric excision during an ileocaecal resection for terminal ileal Crohn’s disease.
The Kono-S is an antimesenteric, functional, end-to-end, handsewn anastomosis that has been shown to be a safe and effective technique to reduce the risk of anastomotic recurrence [3, 4]. In the second part of the video, we demonstrate a step-by-step approach to performing this as part of an ileocaecal resection, with primary anastomosis, for terminal ileal Crohn’s disease.
References
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Zhu Y, Qian W, Huang L, Xu Y, Guo Z, Cao L, Gong J, Coffey JC, Shen B, Li Y, Zhu W (2021) Role of extended mesenteric excision in postoperative recurrence of Crohn’s colitis: a single-center study. Clin Transl Gastroenterol 12(10):e00407. https://doi.org/10.14309/ctg.0000000000000407 (PMID:34597277;PMCID:PMC8483874)
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Acknowledgements
Medical illustration department, Sheffield Teaching Hospitals NHS Foundation Trust, for capturing the operative footage. Medical illustration department, Manchester University NHS Foundation Trust, for producing the illustrations used in this video.
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Selvakumar, D., Sayers, A.E., Brown, S.R. et al. Operative techniques to reduce anastomotic recurrence in Crohn’s disease. Tech Coloproctol 26, 591–592 (2022). https://doi.org/10.1007/s10151-022-02569-1
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DOI: https://doi.org/10.1007/s10151-022-02569-1