International journal of colorectal disease · 2026
Anastomotic configurations and early endoscopic recurrence following ileocolonic resection in Crohn's disease: systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод пока не подготовлен
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Vignali Andrea, Gallo Gaetano, Selvaggi Francesco, Gravante Gianpiero, De Simone Veronica, Foppa Caterina, Allocca Mariangela, Armuzzi Alessandro, Carvello Michele, Cavestro Giulia Martina, De Nardi Paola, Elmore Ugo, Furfaro Federica, Fuschillo Giacomo, Gravina Antonietta Gerarda, Massaro Daniele, Mineccia Michela, Oddis Lidia, Pellino Gianluca, Romano Francesco Maria, Selvaggi Lucio, Siragusa Leandro, Spinelli Antonino, Rosati Riccardo, Danese Silvio, Bemelman Willem, Sileri Pierpaolo
Аннотация
PURPOSE: Crohn's disease (CD) frequently requires surgery, with ileocolonic resection being the most common procedure. Postoperative endoscopic recurrence remains a major concern, and the role of anastomotic configuration is still debated. This systematic review and meta-analysis aimed to evaluate the impact of different anastomotic techniques on early endoscopic recurrence following ileocolonic resection for CD.
METHODS: A systematic search of PubMed, Embase, and Web of Science was performed up to July 2025. Studies comparing stapled side-to-side anastomosis (SSA), handsewn end-to-end anastomosis (EEA), and Kono-S anastomosis (KSA) with postoperative endoscopic follow-up at 6-12 months were included. Study quality was assessed using the Newcastle-Ottawa Scale. Pooled analyses were conducted to compare recurrence rates across anastomotic types.
RESULTS: Eleven studies were included (four comparing SSA vs. EEA; seven comparing KSA vs. SSA), for a total of 1505 patients. Most were retrospective, with three randomised controlled trials available. In pooled analysis, no significant difference was found between SSA and EEA (48.5% vs. 46.7%, test for overall effect Z = 0.41, p = 0.6795). KSA showed a trend towards lower recurrences compared with SSA (31.8% vs. 39.8%, test for overall effect Z = -1.96, p = 0.0495), although heterogeneity in study design, definitions, and postoperative management limits firm conclusions.
CONCLUSIONS: Current evidence does not support a difference in early endoscopic recurrence between SSA and EEA and a potential but weak overall association with lower recurrences for KSA compared to SSA. Large, high-quality prospective trials with standardised definitions, postoperative medical therapy, and follow-up protocols are warranted to clarify the true impact of anastomotic configuration on outcomes in CD.
METHODS: A systematic search of PubMed, Embase, and Web of Science was performed up to July 2025. Studies comparing stapled side-to-side anastomosis (SSA), handsewn end-to-end anastomosis (EEA), and Kono-S anastomosis (KSA) with postoperative endoscopic follow-up at 6-12 months were included. Study quality was assessed using the Newcastle-Ottawa Scale. Pooled analyses were conducted to compare recurrence rates across anastomotic types.
RESULTS: Eleven studies were included (four comparing SSA vs. EEA; seven comparing KSA vs. SSA), for a total of 1505 patients. Most were retrospective, with three randomised controlled trials available. In pooled analysis, no significant difference was found between SSA and EEA (48.5% vs. 46.7%, test for overall effect Z = 0.41, p = 0.6795). KSA showed a trend towards lower recurrences compared with SSA (31.8% vs. 39.8%, test for overall effect Z = -1.96, p = 0.0495), although heterogeneity in study design, definitions, and postoperative management limits firm conclusions.
CONCLUSIONS: Current evidence does not support a difference in early endoscopic recurrence between SSA and EEA and a potential but weak overall association with lower recurrences for KSA compared to SSA. Large, high-quality prospective trials with standardised definitions, postoperative medical therapy, and follow-up protocols are warranted to clarify the true impact of anastomotic configuration on outcomes in CD.