Kono-S vs stapled anastomosis: 12-month endoscopic recurrence
What is the evidence that Kono-S anastomosis reduces endoscopic recurrence at 12 months compared with side‑to‑side stapled anastomosis in CD
What is known
- The SuPREMe-CD randomised trial (79 patients) comparing Kono-S to stapled side-to-side ileocolic anastomosis showed significant reduction in endoscopic and clinical postoperative recurrence. 1
- The KoCoRICCO nationwide propensity-matched study found Kono-S did not reduce endoscopic recurrence versus conventional anastomosis, and its authors rate the overall evidence level as low. 2
- A systematic review and meta-analysis on Kono-S and postoperative recurrence exists but was retrieved only as a reference, without extractable pooled results here. 3,4
What is unknown / caveats
- RCT reports reduced endoscopic recurrence with Kono-S; KoCoRICCO propensity-matched cohort reports no reduction
- Endpoint definitions and exact 12-month recurrence figures are not extractable from the retrieved chunks
- A relevant meta-analysis is cited but its pooled findings were not retrieved as text
- Whether Kono-S confers any durable benefit on surgical (not just endoscopic) recurrence remains unresolved and awaits longer follow-up.
References
- Luglio G, Rispo A, Imperatore N, Giglio MC, Amendola A, Tropeano FP, Peltrini R, Castiglione F, De Palma GD, Bucci L. Surgical Prevention of Anastomotic Recurrence by Excluding Mesentery in Crohn's Disease: The SuPREMe-CD Study - A Randomized Clinical Trial. Ann Surg. 2020. PMID: 32675483.
- Alibert L, Betton L, Falcoz A, Manceau G, Benoist S, Zerbib P, Podevin J, Maggiori L, Brouquet A, Tyrode G, Vuitton L, Vernerey D, Lefevre JH, Lakkis Z. Does Kono-S Anastomosis Reduce Recurrence in Crohn's Disease Compared with Conventional Ileocolonic Anastomosis? A Nationwide Propensity Score-matched Study from GETAID Chirurgie Group [KoCoRICCO Study]. J Crohns Colitis. 2024;18(4):525-532. PMID: 37850342.
- [No authors listed]. Safety and feasibility of the KONO-S anastomosis technique with biodegradable stent in Crohn's disease: a pilot study. Int J Colorectal Dis. 2025;40(1):98. PMID: 40263180.
- [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.
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⚠ Required context not in this corpus (moderate). WITHOUT prophylaxis, ANY endoscopic recurrent lesion in the neoterminal ileum is seen in ~73% within 1 year and ~85% by 3 years of ileocolic resection (Rutgeerts 1990, PMID 2394349). The baseline is the majority, not a minority. (Denominator is any lesion, not a >=i2 cut.)
Why this matters: Understating the untreated recurrence rate makes declining postoperative prophylaxis look reasonable when the expected course is recurrence in most patients.
Added by the landmark interlock. This corpus is surgical in scope and cannot admit the source paper (PMID 2394349). Not generated by the RAG.
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.
Reviewer notes