MEErKAT: MEsenteric Excision and Kono-s Anastomosis Trial

What the researchers are looking at:

MEErKAT is trying to find out if Mesenteric Excision or Kono-S Anastomosis, or both, are better than current types of ileocaecal surgery in helping to prevent the recurrence of Crohn’s Disease. Previous research shows that these surgical methods are safe and both methods are already often used. The study is no longer recruiting new participants as it has met its target with 310 participants involved.

People who have a section of bowel removed due to Crohn’s, have both ends of the remaining bowel surgically joined together. Crohn’s comes back for many people, often near the join. The mesentery is an organ which holds the gut in place and supplies the bowel with blood, lymphatics, nerves and other essentials. Many surgeons feel that the type of surgery used to remove mesentery and join bowel ends can affect the chances of further disease.

Mesenteric Excision removes more of the mesentery during surgery than is usual at present.

Kono-S Anastomosis locates the join away from the mesentery.

The following NHS Trusts and Boards are involved in the study:

• University Hospitals Birmingham NHS Foundation Trust
• Bolton NHS Foundation Trust
• University Hospitals Bristol and Weston NHS Foundation Trust
• Calderdale and Huddersfield NHS Foundation Trust
• Chelsea and Westminster Hospital NHS Foundation Trust
• Royal Cornwall Hospitals NHS Trust
• University Hospitals of Coventry and Warwickshire NHS Trust
• University Hospitals of Derby and Burton NHS Foundation Trust
• Royal Devon University Healthcare NHS Foundation Trust (formerly Royal Devon and Exeter NHS Foundation Trust)
• The Dudley Group NHS Foundation Trust
• NHS Greater Glasgow and Clyde
• Guy's and St Thomas' NHS Foundation Trust
• Kettering General Hospital NHS Foundation Trust
• University Hospitals of Leicester NHS Trust
• London North West University Healthcare NHS Trust
• Manchester University NHS Foundation Trust
• Norfolk and Norwich University Hospitals NHS Foundation Trust
• Northumbria Healthcare NHS Foundation Trust
• Oxford University Hospitals NHS Foundation Trust
• University Hospitals Plymouth NHS Trust
• Sandwell and West Birmingham NHS Trust
• Sheffield Teaching Hospitals NHS Foundation Trust
• University Hospital Southampton NHS Foundation Trust
• Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust

These hospitals are where people who needed ileocaecal surgery agreed to participate. MEErKAT has trained over 30 surgeons in using the Kono-S procedure.

The methods of surgery that each person had was selected by chance from one of four possible options which were:

• Mesenteric Excision with the current join method
• OR Mesenteric Excision with Kono-S join
• OR current mesentery method with Kono-S join
• OR current mesentery with current join methods.

The inside of each person’s bowel is being medically examined around a year later to check for any recurrence of Crohn’s.

Researchers are studying the surgical and medical data for all people participating and are comparing disease recurrence rates for each type of surgery. Where a person suffers a recurrence of Crohn’s the researchers will note to which part of the bowel the disease has returned.

The first patient was enrolled in June 2022 and recruitment finished at the end of January 2026. Throughout the study there will be continuous patient involvement in the way the research is run. Committees overseeing the research include patient representatives. Study data continues to be collected and analysed. The researchers will be presenting the results of this research in 2027. At the end of the study the results will be made publicly available and sent directly to patients who asked to receive it. The results will be made available in a variety of formats and languages to ensure it is accessible.

What the researchers think this might mean for people with Crohn’s and Colitis:

Half of all people receiving ileocaecal surgery for Crohn’s suffer a recurrence of the disease. This research aims to test if Mesenteric Excision and/or the Kono-S Join are better than usual methods in preventing recurrence. If they are better, then use of these methods will help prevent post-operative recurrence of Crohn’s.