Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2024; 16(4): 1165-1175
Published online Apr 27, 2024. doi: 10.4240/wjgs.v16.i4.1165
Impact of different anastomosis methods on post-recurrence after intestinal resection for Crohn's disease: A meta-analysis
Zheng-Zuo Wang, Chun-Hua Zhao, Hui Shen, Gui-Ping Dai
Zheng-Zuo Wang, Department of Anorectal, Jiashan Hospital of Traditional Chinese Medicine, Jiaxing 314100, Zhejiang Province, China
Chun-Hua Zhao, Department of Oncology, Jiashan Hospital of Traditional Chinese Medicine, Jiaxing 314100, Zhejiang Province, China
Hui Shen, Department of Gastroenterology, Jiashan Hospital of Traditional Chinese Medicine, Jiaxing 314100, Zhejiang Province, China
Gui-Ping Dai, Department of Oncology, The Second Hospital of Jiaxing, Jiaxing 314000, Zhejiang Province, China
Co-corresponding authors: Hui Shen and Gui-Ping Dai.
Author contributions: Wang ZZ designed and performed the research; Shen H and Dai GP designed the research and guided and supervised the report; Zhao CH collected information and contributed to the analysis; all authors approved the final manuscript. Shen H and Dai GP contributed equally to this work as co-corresponding authors. To justify the designation of Shen H and Dai GP as co-corresponding authors, we offer the following reasons: Firstly, as integral leaders in our interdisciplinary project, Shen H guided research design and analysis, while Dai GP contributed to research and result interpretation, collectively driving the study's success. Secondly, their coordination bridged diverse expertise, enhancing team collaboration and fostering an innovative research environment, underscoring the value of co-authorship. Lastly, both authors made substantial, equal contributions across all research phases, warranting their joint recognition as co-corresponding authors. In brief, Shen H and Dai GP's co-authorship accurately captures their shared responsibilities and contributions, reflecting our team's collaborative ethos and interdisciplinary approach.
Conflict-of-interest statement: Dr. Shen has nothing to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2020 Checklist of items, and the manuscript was prepared and revised according to the PRISMA 2020 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Hui Shen, MBBS, Attending Doctor, Department of Gastroenterology, Jiashan Hospital of Traditional Chinese Medicine, No. 38 Gujiadai, Jiashan County, Jiaxing 314100, Zhejiang Province, China.
Received: December 22, 2023
Peer-review started: December 22, 2023
First decision: January 9, 2024
Revised: January 18, 2024
Accepted: March 28, 2024
Article in press: March 28, 2024
Published online: April 27, 2024

Crohn's disease (CD) is a chronic inflammatory disease of the gastrointestinal tract, often requiring intestinal resection as a common treatment. However, recurrence after surgery is common. The anastomotic configuration after bowel resection appears to be associated with the recurrence of CD. Previous studies have suggested that the Kono-S anastomosis may help to reduce the recurrence rate. However, the results remain controversial. Therefore, evidence-based evidence is needed to prove the advantages of Kono-S anastomosis.


To measure the influence of anastomosis techniques on the long-term relapse rate of CD by conducting a meta-analysis.


PubMed, Scopus, and Cochrane Library were searched until October 8, 2023. Patients who underwent intestinal resection due to CD were included. The intervention measures included Kono-S anastomosis, whereas the control group received traditional anastomosis such as end-to-end, end-to-side, and side-to-side anastomosis. Only randomized clinical trials and observational studies were included. The primary outcome measures were hospital stay post-surgery, overall postoperative complication incidence, the proportion of Clavien-Dindo grade IIIa or higher, overall postoperative recurrence rate, and Rutgeerts score.


From 2011 to 2023, six articles met the inclusion and exclusion criteria. The results indicated that Kono-S anastomosis can reduce the hospital stay post-surgery of patients with CD [MD = -0.26, 95%CI: -0.42 to -0.10, P = 0.002] than other traditional anastomosis methods. Compared to other traditional anastomosis methods, Kono-S anastomosis can significantly reduce the total recurrence rate [MD = 0.40, 95%CI: 0.17 to 0.98, P = 0.05] and postoperative Rutgeerts score [MD = -0.81, 95%CI: -0.96 to -0.66, P < 0.001] in patients with CD. However, there is no significant disparity in the overall occurrence of postoperative complications and the proportion of Clavien-Dindo ≥ IIIa.


Kono-S anastomosis has the potential to expedite the recuperation of CD and diminish relapse hazards; however, additional larger trials are necessary to authenticate its effectiveness.

Keywords: Kono-S, Crohn’s disease, Traditional anastomosis, Postoperative recurrence, Meta-analysis

Core Tip: There is no agreement in academic studies regarding the impact of Kono-S and traditional anastomosis on patients' recurrence after Crohn's surgery. Here, we present a primary inclusive meta-analysis exploring the effect of Kono-S and traditional anastomosis on the recurrence of Crohn's disease following surgery. The hospital stay post-surgery, the incidence of postoperative complications, the proportion of Clavien-Dindo ≥ IIIa, the postoperative recurrence rate, and the Rutgeerts score were examined in patients who underwent the two techniques.