Preventing Crohn's recurrence, Kono-S and extended mesenteric excision: network meta-analysis category

Introduction Crohn’s disease (CD) is a complex disease with rising incidence that is usually treated with medical management. However, surgery plays an important role for medically refractive cases, or Crohn’s related complications. New techniques such as extended mesenteric excision (EME), and Kono-S anastomosis (KSA) are being increasingly adopted. However, their potential for reducing CD recurrence remains unclear. Method Studies were identified through searching Medline, Embase, Cochrane Library and JBI EBP from database inception to January 2025. Studies where patients with CD had intestinal resection and underwent at least two of four interventions being KSA, other anastomosis, EME and/or limited mesenteric excision (LME) were included. Two investigators independently identified studies and abstracted data. RCT quality was assessed using Cochrane Risk of Bias 2 tool and cohort study quality assessed using Newcastle Ottawa Scale. The study adhered to PRISMA guidelines. Bayesian network meta-analysis was conducted to assess risk of surgical and endoscopic recurrence at 5 years and 6–12 months respectively. Results Thirteen studies composed of 3 RCTs and 10 cohort studies (n = 2,044) were included, assessing surgical and/or endoscopic recurrence after KSA, other anastomosis, EME or LME. There was statistically significant reduction in surgical recurrence in KSA compared to other anastomosis (odds ratio 0.07, 95% credible interval) but not EME compared to LME. There was no difference in endoscopic recurrence in any groups. Conclusion KSA was associated with reduced surgical recurrence compared with other anastomosis, but not endoscopic recurrence. There were insufficient studies to support similar improvement in recurrence in EME over LME.