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4 Smart NJ, Pathak S, Boorman P, Daniels IR. Synthetic or biological mesh use in laparoscopic ventral mesh rectopexy – a systematic review. Colorectal Dis 2013; 15: 650–4. 5 Mathew MJ, Parmar AK, Reddy PK. Mesh erosion after laparoscopic posterior rectopexy: a rare complication. J Minim Access Surg 2014; 10: 40–1. 6 Mercer-Jones M, D’Hoore A, Dixon A et al. Consensus on ventral rectopexy: report from a panel of international experts. Colorectal Dis 2014; 16: 82–8. 7 Faucheron JL, Voirin D, Riboud R, Waroquet PA, Noel J. Laparoscopic anterior rectopexy to the promontory for full-thickness rectal prolapse in 175 consecutive patients: short- and long-term follow-up. Dis Colon Rectum 2012; 55: 660–5.

The Kono-S anastomosis is a technically feasible procedure that appears to be safe and effective in preventing anastomotic surgical recurrence in Crohn’s disease, although prospective studies are needed to confirm our findings.

T. Kono*† and A. Fichera‡ *Advanced Surgery Center, Sapporo Higahsi Tokushukai Hospital, 3-1, N 33, E 14, Higahi-ku, Sapporo, Hokkaido, 065-0033, Japan; †Department of Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School of Medicine, Tokushima, 770-8503, Japan and ‡Division of General Surgery, Department of Surgery, University of Washington Medical Center, 1959 NE Pacific Street, Box 356410, Room BB-414, Seattle, WA, 98195, USA E-mail: [email protected] Received 4 July 2014; accepted 7 July 2014; Accepted Article online 12 July 2014

Kono-S anastomosis for Crohn’s disease: narrative – a video vignette doi:10.1111/codi.12722

Dear Sir, Anastomotic surgical recurrence after bowel resection is a major problem in Crohn’s disease [1]. To date, no anastomotic technique has been proven to be superior in reducing surgical recurrence rates in this setting. In 2003 a new combined stapled and hand-sewn antimesenteric functional end-to-end anastomosis (Kono-S anastomosis) was designed to minimize surgical recurrence [2]. In this video report, we describe our technique for performance of a new antimesenteric functional end-to-end handsewn (Kono-S) anastomosis [3] (Video S1). The Kono-S anastomosis technique is accomplished by transecting the bowel with a linear cutter so that the mesentery side is located in the centre of the stump after the intervening mesentery has been divided close to the bowel. Both stumps are sutured together to create a supporting column to maintain the diameter and dimension of the anastomosis. Longitudinal enterotomies are made on the antimesenteric sides of the two segments of intestine. The side-to-side antimesenteric anastomosis is then performed in a transverse fashion. One hundred and eighty-eight patients with Crohn’s disease (140 Japanese and 48 American) who underwent Kono-S anastomosis at five hospitals (four in Japan and one in the United States) from 2003 to 2013 were reviewed. The Kono-S anastomosis was successfully performed in all patients with excellent results. No deaths were reported and only two anastomotic leaks occurred during the study period. Kaplan–Meier analysis showed no anastomotic surgical recurrence at 10 years.

References 1 Fichera A, Michelassi F. Surgical treatment of Crohn’s disease. J Gastrointest Surg 2007; 11: 791–803. 2 Kono T, Ashida T, Ebisawa Y et al. A new antimesenteric functional end-to-end handsewn anastomosis: surgical prevention of anastomotic recurrence in Crohn’s disease. Dis Colon Rectum 2011; 54: 586–92. 3 Fichera A, Zoccali M, Kono T. Antimesenteric functional end-to-end handsewn (Kono-S) anastomosis. J Gastrointest Surg 2012; 16: 1412–6.

Supporting Information The video may be found in the online version of this article and also on the Colorectal Disease Journal YouTube and Vimeo channels: Video S1. Technique for performance of a new antimesenteric functional end-to-end handsewn (Kono-S) anastomosis.

Single-incision laparoscopic subtotal colectomy through ileostomy site for ulcerative colitis – a video vignette doi:10.1111/codi.12728

Dear Sir, We present the case of a 33-year-old male patient who underwent single-incision laparoscopic subtotal colectomy for ulcerative colitis (UC). The patient was an ideal candidate for single-incision laparoscopic surgery (SILS), with a body mass index of 20.5, no history of previous abdominal surgery and a

Colorectal Disease ª 2014 The Association of Coloproctology of Great Britain and Ireland. 16, 831–836

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benign condition. He was diagnosed with UC 12 months previously and because of failure of medical treatment it was decided to proceed to a three-stage restorative proctocolectomy. To perform a completely ‘scarless’ procedure, the SILS port was inserted at the site of the ileostomy, which was preoperatively marked. This technical choice made mobilization of the caecum and the terminal ileum particularly challenging, as the operative field was immediately under the port. The video demonstrates the main steps of a ‘left to right’ subtotal colectomy, with an early division of the sigmoid colon to facilitate the traction (Videoclip S1). An articulating vessel sealing device was used to minimize the disadvantages of the loss of triangulation. The length of surgery was 72 min. The patient had an uneventful recovery and was discharged home on postoperative day 3. The innovative technique demonstrated in this patient can be safely applied to selected patients in dedicated laparoscopic colorectal units.

V. Celentano, J. P. Griffith and J. M. Robinson Bradford Royal Infirmary, Bradford, UK E-mail: [email protected] Received 4 April 2014; accepted 28 April 2014; Accepted Article online 21 July 2014

improve inadvertent consequences of segmental resection of the rectum, we recently proposed the combined laparoscopic and transanal disc excision of large endometriotic nodules of the lower and mid rectum [3,4]. However, disc excision still requires sutures of the low and mid rectum, with a theoretical risk for leakage and postoperative infectious complications. Furthermore, in large nodules involving both the rectum and the vagina, simultaneous rectal and vaginal sutures increase the risk of rectovaginal fistulae and usually require preventive discontinuous stoma [5]. Today, in the associated video, we are proposing a technique of deep rectal shaving suitable in women with deep endometriosis responsible for rectal stenosis (Fig. 1), which combines excision of the endometriotic nodule with in situ ablation of residual fibrous tissue. The procedure is made feasible by the specific properties of the PlasmaJet device (Plasma Surgical Ltd, Roswell, GA, USA) (Fig. 2) [6]. In our opinion, our technique is reproducible and safe, perfomed thus far in 46 patients since January 2013, with favourable postoperative outcomes in all cases. The main advantage of the procedure resides in the fact that it relieves rectal stenosis without opening the rectal wall and suturing it. Avoiding rectal opening reasonably decreases the risk of postoperative complications related to sutures of the mid and lower rectum. Performing rectal shaving using PlasmaJet provides an anatomical result that is most satisfactory (Fig. 3). As the

Supporting Information The video may be found in the online version of this article and also on the Colorectal Disease Journal YouTube and Vimeo channels: Video S1. Single incision laparoscopic subtotal colectomy through ileostomy site for ulcerative colitis.

Deep rectal shaving using plasma energy for endometriosis causing rectal stenosis a video vignette doi:10.1111/codi.12720

Dear Sir, A large majority of surgeons agree that rectal endometriotic nodules responsible for stenosis cannot be managed by conservative surgery and require mandatory colorectal resection. This procedure results in a complete resection of the rectal implants but may lead to unfavourable rectal functional outcomes [1,2]. To

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Figure 1 Computed tomography based virtual colonoscopy revealing a deep endometriotic nodule infiltrating the rectum over 40 mm, with inferior limit located 10 cm above the anus and responsible for stenosis (the diameter of the rectum could not be distended over 7 mm).

Colorectal Disease ª 2014 The Association of Coloproctology of Great Britain and Ireland. 16, 831–836

Single-incision laparoscopic subtotal colectomy through ileostomy site for ulcerative colitis - a video vignette.

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