Kono-S vs stapled anastomosis: leak after ileocolic resection

What is known

• A single-center retrospective cohort of 25 patients compared stapled vs handsewn Kono-S ileocolonic anastomosis. Anastomotic leak, presumed on CT, occurred in 2 of 10 stapled patients (20%) and 2 of 15 handsewn patients (13.3%), p=0.65, with only one surgically proven leak (handsewn group). Both arms were Kono-S, so it does not report a Kono-S vs side-to-side stapled leak comparison. ¹
• A single-center retrospective comparison of 122 consecutive elective resections found side-to-side stapled anastomosis strongly reduces leak rates versus handsewn end-to-end anastomosis after ileocecal/ileocolonic resection. The comparator is end-to-end, not Kono-S. ²
• A retrospective single-center series of 308 patients undergoing 343 ileocolic resections (1993 - 2007) found a lower recurrence rate with side-to-side antiperistaltic anastomosis than with the other configurations (8.2% vs 26.9%, p=0.002), while overall morbidity was 7.3% with no significant difference between groups. Its endpoint was recurrence, not leak, and Kono-S was not studied. ³
• A propensity-score-adjusted single-center cohort of 269 stapled ileocolic resections found that oversewing the staple line was associated with fewer major anastomotic complications, a category that included anastomotic leak (OR 0.37). Every anastomosis in that cohort was stapled, so it offers no handsewn or Kono-S comparison. ⁴

What is unknown / caveats

• No retrieved study puts Kono-S handsewn against conventional side-to-side stapled for leak rate
• The Kono-S cohort is small (n=25) and retrospective, and its authors state it is not powered to detect differences in low-incidence events such as leak
• Stapled-vs-handsewn leak evidence uses end-to-end, not side-to-side, as the handsewn comparator in that study
• The specific two-arm comparison you ask about is not established by the retrieved evidence.

References

1. [No authors listed]. Comparing perioperative outcomes of stapled versus handsewn Kono-S anastomosis after ileocolonic resection for Crohn's disease. Tech Coloproctol. 2025;29(1):182. PMID: 41099860.

2. Resegotti A, Astegiano M, Farina EC, Ciccone G, Avagnina G, Giustetto A, Campra D, Fronda GR. Side-to-side stapled anastomosis strongly reduces anastomotic leak rates in Crohn's disease surgery. Dis Colon Rectum. 2005;48(3):464-8. PMID: 15719193.

3. [No authors listed]. [Role of anastomotic configuration in ileocolic resection for Crohn's disease]. Chir Ital. 2009;61(1):23-31. PMID: 19391336.

4. [No authors listed]. Oversewing staple lines to prevent anastomotic complications in primary ileocolic resections for Crohn's disease. J Gastrointest Surg. 2015;19(5):911-6. PMID: 25773759.

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Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct.