Kono-S vs stapled side-to-side anastomosis: recurrence

What is known

• The Luglio RCT reported endoscopic recurrence (i2 or greater) of 22.2% with Kono-S vs 62.8% with stapled side-to-side after ileocolic resection. ¹
• A prospective cohort with systematic postoperative endoscopic review concluded Kono-S is not superior to conventional anastomosis for reducing postoperative endoscopic recurrence. ²
• Retrospective Japanese series report higher long-term surgery-free rates with Kono-S vs end-to-end, but these are surgical-recurrence, not 12-month endoscopic, endpoints. ^1,3

What is unknown / caveats

• Luglio RCT shows Kono-S superiority on endoscopic recurrence ¹; a prospective cohort finds no superiority over conventional anastomosis ²
• No retrieved study compares handsewn Kono-S vs stapled side-to-side on 12-month endoscopic recurrence specifically
• The stapled-vs-handsewn Kono-S comparison retrieved reports only perioperative outcomes, not recurrence ⁴
• The question conflates two distinct comparisons. Kono-S vs stapled side-to-side, and handsewn vs stapled Kono-S, and the retrieved evidence does not isolate the handsewn factor.

References

1. 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.

2. Tyrode G, Lakkis Z, Vernerey D, Falcoz A, Clairet V, Alibert L, Koch S, Vuitton L. KONO-S Anastomosis Is Not Superior to Conventional Anastomosis for the Reduction of Postoperative Endoscopic Recurrence in Crohn's Disease. Inflamm Bowel Dis. 2024;30(10):1670-1677. PMID: 37776562.

3. [No authors listed]. State-of-the-art surgery for Crohn's disease: Part I-small intestine/ileal disease. Langenbecks Arch Surg. 2022;407(3):885-895. PMID: 34738167.

4. [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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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.