A Modified Totally Stapled KONO-S Anastomosis for Ileal and Ileo-colic Crohn's Disease: Technical Aspects and Case Series

Overview

Journal Updates Surg

Date 2025 Feb 2

PMID 39893597

Authors

Xiujun Liao

Michele Cricri

Yang Tang

Pan Sun

Massimo Mongardini

Ludovico Docimo

Salvatore Tolone

Federico Maria Mongardini

Affiliations

Soon will be listed here.

Abstract

Crohn's disease (CD) is a chronic immune-mediated disorder affecting the gastrointestinal tract. While medical therapies have advanced, approximately 80% of CD patients will require surgery due to disease recurrence. A significant debate exists regarding the primary site of post-operative recurrence. This discrepancy in recurrence patterns underscores the complexity of CD management and the ongoing need for tailored surgical approaches. It has been recently demonstrated that the Kono-S anastomosis is safe and efficient in reducing endoscopic and surgical recurrence. Newer versions of the Kono-S anastomosis using staplers have been reported to further simplify the procedure and decrease operative time. The aim of this paper was to describe a distinct version of a totally stapled Kono-S anastomosis and provide preliminary results from our center. The technical procedure of a totally stapled Kono-S anastomosis is illustrated. A consecutive series of patients undergoing ileal or ileo-colic resection followed by totally stapled Kono-S anastomosis was identified from a prospectively collated database. Data included patient demographics and baseline characteristics, intraoperative details, short- and long-term post-operative outcomes. Between January and November 2023, 41 patients (mean age 36.4 years, 61% males) underwent ileal or ileo-colic resection followed by totally stapled Kono-S anastomosis for Crohn's disease. Mean operative time was 150.76 ± 43.22 min, and mean time of anastomotic construction was 19.71 ± 4.24. Time to flatus and stool were 2.73 ± 0.70 and 3.51 ± 1.16 days, respectively, and the length of post-operative stay was 6.80 ± 2.13 days. Only two patients (4.8%) presented complications following surgery, namely anastomotic bleeding. At a mean follow-up of 17.0 ± 2.1 months, no patient needed re-do surgery for disease recurrence at anastomotic site. The endoscopic recurrence rate was 14.4% (4/28). Our fully stapled version of the Kono-S anastomosis is safe and feasible, and short construction time and low technical complexity may help its diffusion among colorectal surgeons. Long-term outcomes on disease recurrence are still to be defined.

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