Long-term outcomes of Kono-S anastomosis for ileocecal resections in Crohn's disease: a comparative analysis.

OBJECTIVE

This long-term follow-up study evaluates clinical and functional outcomes after ileocecal resection with either Kono-S or conventional anastomosis techniques in patients with Crohn's disease. The goal was to determine whether the Kono-S approach confers a long-term advantage in preventing disease recurrence and improving quality of life. While the Kono-S anastomosis has shown promise in reducing recurrence rates in Crohn's disease following surgery, most existing evidence stems from short- to medium-term follow-up. High-quality long-term data remain scarce, particularly in real-world clinical settings. This study aims to fill that gap.

METHODS

A retrospective-prospective cohort analysis was performed including patients who underwent ileocecal resection for Crohn's disease between 2015 and 2017 at a single academic center. Patients were grouped according to anastomosis technique (Kono-S vs. conventional). Long-term follow-up data were obtained via chart review, imaging studies, and patient-reported questionnaires, including the Gastrointestinal Quality of Life Index (GIQLI). Primary outcomes included recurrence rates, postoperative complications, and quality of life.

RESULTS

Seventy patients were included in the final analysis (Kono-S: n = 31; conventional: n = 39). The median follow-up duration was 8.1 years (interquartile range = 6.9-8.8 years). No significant differences were observed between groups regarding endoscopic inflammation (Kono-S = 19.4%, conventional = 25.6%, p = 0.39), restenosis (Kono-S = 9.7%, conventional = 2.6%, p = 0.34), or GIQLI scores (Kono-S: median 116 vs. 110, p = 0.08). Rehospitalization rates were numerically higher in the Kono-S group (16.1% vs. 2.6%, p = 1.0), but not statistically significant. Importantly, approximately 40% of all patients retrospectively stated they would have preferred earlier surgical intervention, independent of the anastomotic technique.

CONCLUSION

After more than 7 years of follow-up, the Kono-S anastomosis demonstrates comparable long-term outcomes to conventional techniques in terms of recurrence, complications, and quality of life. Patient reflections suggest a potential benefit of earlier surgical intervention, highlighting the need for more proactive surgical referral in gastroenterological practice.