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.