Recurrence in Crohn's disease: the impact of surgical technique on medium- and long-term outcomes

Although medical management has improved significantly, surgery plays an important role in the treatment of Crohn's disease. However, it is not curative, and recurrence - often occurring at or near the site of previous anastomosis - is common. To reduce postoperative recurrence, 2 surgical strategies have garnered increasing attention: the Kono-S anastomosis, which modifies anastomotic configuration, and extended mesenteric excision (EME), which targets the diseased mesentery thought to contribute to recurrence.

The theoretical basis and rationale of Kono-S anastomosis and EME were discussed, and a critical review of the current literature evaluating their efficacy was performed. Data were drawn from retrospective series, prospective cohort studies, and randomized controlled trials (RCTs), with attention to the current state of evidence.

Early studies of the Kono-S anastomosis demonstrated impressively low rates of surgical recurrence. Data on its effect on endoscopic recurrence have varied but randomized data on surgical recurrence are pending. Similarly, retrospective analyses of EME suggested a reduced risk of recurrence, although results across recent studies have varied - potentially because of differences in operative technique or definitions of mesenteric excision.

High-quality data from several ongoing RCTs will help define the roles of the Kono-S anastomosis and EME in reducing recurrence rates for patients with Crohn's disease.