Relief from the Symptoms of Crohn’s Disease, Through Surgery

For people with Crohn’s disease, a normal day might include abdominal pain, cramping and diarrhea. They might feel tired, fight a fever or have no appetite.

For the 780,000 Americans with Crohn’s disease, these struggles are part of day-to-day life. Crohn’s is an inflammatory bowel disease in which the body’s immune system attacks and damages the digestive tract. The exact cause of Crohn’s is not known, but it is thought to be brought on by factors including age, diet, ethnicity, smoking, medication use, family history and where you live.

Crohn’s disease may affect the entire gastrointestinal tract, but it most commonly affects the small intestine or colon, where it can cause severe inflammation and infections. That inflammation makes the tissue more delicate and allows sores and ulcers to form. In severe cases, this can lead to a perforation—or a hole—in the intestines. Inflammation also causes the walls of the intestines to thicken, restricting the space food or stool has to pass through and creating a blockage.

Ulcers, perforation and blockages are not only painful, but they also prevent the body from functioning normally and can lead to life-threatening problems, such as sepsis. About 70 percent of Crohn’s disease patients will need surgery to fix one of those issues, according to the Crohn’s and Colitis Foundation.

How Kono-S Surgery Can Help

Fixing a perforated or infected portion of the intestine is often a lifesaving operation called resection. To fix the intestine, a surgeon removes the damaged area and performs an anastomosis, which means the two parts of the intestine that have been separated are reconnected. That reconnection can be done using several methods.

One fairly new method is the Kono-S anastomosis. Named after its creator, Japanese physician Toru Kono, MD, it has been practiced in Japan since 2003 and in the U.S. since 2010. A limited number of physicians from around the world have learned this method from Dr. Kono. One of them is Alessandro Fichera, MD, chief of gastrointestinal surgery in the UNC Department of Surgery.

“I have been using the Kono-S anastomosis for my Crohn’s patients because I believe it lowers the chances they will have a recurrence of Crohn’s disease that requires another surgery,” Dr. Fichera says.

Dr. Fichera has practiced this method for seven years at different institutions. He has also been involved in clinical trials to prove the effectiveness of the method that he and other physicians believe is superior to traditional anastomosis techniques. Dr. Fichera is using the Kono-S anastomosis at UNC and is the only Kono-taught physician in the South offering the method.

About 30 percent of patients will have a flare-up of Crohn’s within three years of a surgery that includes traditional anastomosis, and 60 percent will have one within 10 years. The recurrence usually happens close to the anastomosis site. To keep track of this, patients receive an endoscopy one year after surgery to look for signs of new damage from Crohn’s. Initial studies have demonstrated that the Kono-S anastomosis has prevented recurrence of Crohn’s disease at one year after surgery at greater rates than traditional anastomosis.

“Kono-S is more time-consuming than traditional anastomosis, especially the way I do it,” Dr. Fichera says. “I hand-sew the portions of intestine back together instead of using staples, which don’t offer me the ability to customize each stitch. Each resection is different, and by hand-sewing the anastomosis with the Kono-S method, I can tailor each connection for a better overall result.”

Expanding the Kono-S Method

Dr. Fichera has completed six Kono-S surgeries for people with Crohn’s disease in the eight months he has been at UNC. He completed 124 at his previous institutions.

Dr. Fichera says the Krono-S method can be used for patients who need a bowel resection for any reason, though the clinical trials being conducted are specifically for Crohn’s patients. Dr. Fichera hopes to enlist UNC in a national multicenter clinical trial to further study the benefits of Kono-S over other anastomosis methods.

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