eP261 - Improved Short-term Outcomes Following Kono-S Anastomosis for Crohn’s Disease

ePoster Presenter(s)

• 

  Amber M. Moyer, MD (she/her/hers)

  Fellow
  Penn State Health Milton S. Hershey Medical Center
  Penn State Health Milton S. Hershey Medical Center
  Harrisburg, PA, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• 

  Olivia Ziegler, MD

  General Surgery Resident
  Penn State Hershey
  Penn State Milton S Hershey Medical Center
  Hershey, PA, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• MQ

  Mckell Quattrone, MD

  Resident physician
  Penn State Milton S. Hershey Medical Center
  Hershey, Pennsylvania, United States

  Disclosure information not submitted.
• JP

  Ji Ho Park, MD

  Resident Physician
  Penn State Hershey Medical Center
  Hummelstown, Pennsylvania, United States

  Disclosure information not submitted.
• NJ

  Nimalan A. Jeganathan, MD

  Associate Professor of Surgery
  The Ohio State University Wexner Medical Center
  Columbus, Ohio, United States

  Disclosure information not submitted.
• AK

  Audrey Kulaylat, MD MSc FACS

  Associate Professor of Colon and Rectal Surgery
  Penn State Health
  Hershey, Pennsylvania, United States

  Disclosure information not submitted.
• MD

  Michael Deutsch, MD, FACS

  Assistant Professor of Surgery
  Dept of Colorectal Surgery
  Hershey, Pennsylvania, United States

  Disclosure information not submitted.
• 

  Walter Koltun, MD

  Chief, Div Colorectal Surgery
  Penn State
  Hershey, Pennsylvania, United States

  Disclosure information not submitted.
• JS

  Jeffrey S. Scow, MD

  Assistant Professor of Surgery
  Penn State Milton S. Hershey Medical Center
  Hershey, Pennsylvania, United States

  Disclosure information not submitted.

Purpose/Background: While the Kono-S anastomosis for Crohn’s disease has been shown to have improved long-term outcomes, namely lower rates of endoscopic recurrence, endoscopic disease severity scores, and clinical recurrence, the aim of this study was to evaluate short-term post-operative outcomes following Kono-S anastomosis in patients with Crohn’s disease.Methods/Interventions: Patients with Crohn’s disease who underwent creation of a Kono-S anastomosis at Penn State Health Milton S Hershey Medical Center between 2021-2023 were identified. Patient demographics, disease biology and management, operative characteristics, and 90-day post-operative complications were analyzed.Results/Outcomes: We identified 38 patients at our tertiary referral center who underwent Kono-S anastomosis for Crohn’s disease. The median age was 41.2 years, 50% (n=19) were female, and 92% (n=35) were white. Pre-operative characteristics included a median BMI of 23.0 mg/k2, median albumin of 4.2 g/dL, median CRP of 0.4 mg/dL, and median ESR of 18.0 mm/hr. At the time of surgery, most patients (58%, n=22) were receiving corticosteroids, including 9 inpatients (24%) on IV steroids. Biologics were used in 84% (n=32). Only 13% (n=4) were current smokers. Most patients were classified as ASA II (47%, n=18) or III (45%, n=17). The indications for surgery included stricturing disease (66%, n=25), fistulizing disease (16%, n=6), or stricturing and fistulizing disease (18%, n=7). Most operations were minimally invasive with 24% (n=9) laparoscopic, 24% (n=9) hand-assisted laparoscopic, and 3% (n=1) robotic, but 13% (n=5) required conversion to an open procedure. Only 13% (n=5) underwent proximal diversion. The median estimated blood loss was 50.0 ml and median operative time was 217.5 minutes. The median length of stay was 5 days. The rate of major complications (Clavien-Dindo 3 or higher) within 90-days was 5% (n=2). There were no occurrences of anastomotic leak or anastomotic bleeding. In this cohort, five (13%) patients had surgical site infections, three (8%) of which were organ space and one (3%) required intervention for aspiration. Additionally, seven (18%) patients had an ileus requiring nasogastric tube decompression, two (5%) had urinary retention, and one (3%) was treated for a urinary tract infection. One (3%) patient required reoperation for fascial dehiscence on post-operative day 22. Only three (8%) patients required readmission (Table 1). There were no cardiac, thromboembolic, or renal complications.Conclusion/

Discussion: The Kono-S anastomosis is associated with an acceptable rate of short-term complications. Historically, ileocolonic anastomoses in Crohn’s disease are associated with at least a 6.4% rate of anastomotic leak. In our series of 38 patients with not insignificant comorbidities, we had no leaks or bleeds suggesting adoption of this technique may provide immediate post-operative benefit in addition to long-term disease reduction.Patient demographics, operative characteristics, and post-operative complications