Comparing perioperative outcomes of stapled versus handsewn Kono-S anastomosis after ileocolonic resection for Crohn's disease.

INTRODUCTION

Ileocecal resection is the most common surgery in Crohn's disease (CD). As recurrences often occur at the anastomosis it has been questioned whether surgical technique may have a role in its prevention. The Kono-S anastomosis, first described in 2011, has shown potential to reduce anastomotic recurrence while maintaining luminal width and preventing distortion. The classic surgery described was a handsewn anastomosis. Lately a stapled approach has emerged which is less technically demanding, and requires shorter operative time. We compared stapled versus handsewn Kono-S ileocolonic anastomosis in patients with Crohn's disease, evaluating operative time and perioperative outcomes.

METHODS

Data on all consecutive patients with CD aged ≥ 18 years at a single tertiary center, who underwent ileocolonic resection by inflammatory bowel disease (IBD)-dedicated surgeons with Kono-S anastomosis from July 2023 to April 2025, were collected retrospectively.

RESULTS

In total, 25 patients were included. Overall, 15 (60%) underwent handsewn anastomosis and 10 (40%) underwent stapled anastomosis. There were no clinical or demographic differences. Median operative time was shorter in the stapled group (151 versus 203 min, p = 0.01). Postoperative complications occurred in 2/10 patients (20%) in the stapled group and 4/15 (26.7%) in the handsewn group (p = 0.70). One patient required reoperation in the handsewn group. Postoperative day 3 C-reactive protein (CRP) was lower in the stapled group (median 69 versus 165 mg/L, p = 0.03). There was one case of 30-day rehospitalization in the stapled group.

CONCLUSIONS

The stapled Kono-S anastomosis technique is a shorter procedure with similar perioperative outcomes compared with the handsewn technique. Follow-up studies, with larger sample sizes, are required to evaluate long-term efficacy and disease recurrence rates.