Kono-S vs hand-sewn anastomosis: endoscopic recurrence
What is the evidence that Kono‑S anastomosis during ileocolic resection reduces endoscopic recurrence at 12 months compared with conventional hand‑sewn anastomosis
What is known
- SuPREMe-CD randomized 79 ileocolic CD patients and reported significantly reduced postoperative endoscopic and clinical recurrence with Kono-S; the Luglio RCT reported i2+ recurrence 22.2% vs 62.8% (stapled side-to-side). 1,2
- A 2024 meta-analysis (17 studies, 2087 patients) found lower pooled endoscopic recurrence with Kono-S (24.7%) versus conventional (42.6%). 3
- A second RCT (NCT03256240) showed no significant difference in endoscopic recurrence at 12–18 months; clinical disease activity and CD subtype predicted recurrence independent of technique. 1
- A long-term cohort with median follow-up >8 years found no significant difference in endoscopic recurrence, restenosis, reoperation, or QoL between Kono-S and conventional anastomosis. 4
What is unknown / caveats
- Early RCT and pooled analyses show reduced recurrence with Kono-S
- A second RCT and long-term cohort show no sustained recurrence benefit
- Positive trials had short follow-up (~2 years) and small samples
- Many supporting studies retrospective or relied on operative rather than endoscopic recurrence
- The ongoing MErKAT factorial RCT is designed to isolate the independent effects of Kono-S (and extended mesenteric excision) and has not yet reported.
References
- [No authors listed]. Effect of extensive mesenteric excision on primary ileocolic resection outcomes in Crohn's disease patients: a systematic review with meta-analysis. Int J Colorectal Dis. 2025;40(1):243. PMID: 41329358.
- Clark DA. Ileocolic resection for Crohn's disease and the Kono S anastomosis: all that is gold does not glitter. ANZ J Surg. 2024;94(12):2101-2102. PMID: 39073259.
- Nardone OM, Calabrese G, Barberio B, Giglio MC, Castiglione F, Luglio G, Savarino E, Ghosh S, Iacucci M. Rates of Endoscopic Recurrence In Postoperative Crohn's Disease Based on Anastomotic Techniques: A Systematic Review And Meta-Analysis. Inflamm Bowel Dis. 2024;30(10):1877-1887. PMID: 37931290.
- Vojta M, Hermann M, Kienle P, Reißfelder C, Weiß C, Hardt J, Seyfried S. Long-term outcomes of Kono-S anastomosis for ileocecal resections in Crohn's disease: a comparative analysis. Int J Colorectal Dis. 2026;41(1):54. PMID: 41629511.
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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