Totally stapled Kono-S anastomosis for Crohn’s disease

Anastomosis after Bowel Resection for Crohn's Disease: State of the Art Review

“…In a prospective longitudinal study involving 78 patients operated on by the same team for primary CD as well as for the subsequent recurrence, the authors noted that the site of the original operative intervention was the most common site for recurrence, specifically the pre-anastomotic ileum after ileocolic resection. 22 The same findings were illustrated by Bislenghi et al 23 The preanastomotic ileum as the inlet of the SSSA maintains a critical fixed diameter irrespective of the orientation (iso vs. antiperistaltic) and the size of the anastomotic lumen, and there is where stasis occurs resulting in the prevalence of recurrence at that level. A recently published revised endoscopic recurrence score proposed by the same group defined six perianastomotic areas to be endoscopically evaluated and scored, including the ileal inlet after SSSA.…”

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“…Before starting the anastomosis process, the stumps must be sutured by 4 or 5 stitches together so that they can form a support column, hence the name Kono-S, as a support, which the objective of the technique is to maintain the orientation and large diameter of the anastomosis lumen. Longitudinal enterotomies of approximately 7-8 cm are then performed to obtain a transverse lumen on the antimesenteric side, 0.5-1 cm from the supporting column to further enhance the supporting effect of the column on the anastomosis (Kono et al, 2011;Kono et al, 2011;Kono et al, 2016;Katsunu et al, 2015;Bislenghi et al, 2022) The anastomosis is then created transversely using the hand-stitching technique with continuous one-or two-layer Vicryl 3/0 sutures, which will culminate in a large anastomosis, in addition to a rigid and stable support to avoid mechanical deformation and functional constriction of the anastomotic lumen compared to a "posterior bone" of the anastomosis. Since the recurrence occurs mainly on the mesenteric side of the anastomosis, the Kono technique is capable of ekiminating the mesentery from the anastomotic surface, and maintaining the innervation and vascularization of the intestine, both factors are related in the process of recurrence and consolidation of the anastomosis.…”

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“…The mesentery of the intestinal segment to be excised is initially sectioned at the mesenteric border of the intestinal wall using a vessel-sealing system in order to prevent unnecessary devascularization and denervation of the residual intestine, thereby maintaining an adequate blood supply. as the neural control for local anastomosis (fichera et al, 2012;Katsuno et al 2015;Bislenghi et al, 2022).…”