KONO-S TECHNIQUE IN PATIENTS WITH CROHN'S DISEASE ILEOCECAL: INITIAL EXPERIENCE IN A TERTIARY UNIVERSITY HOSPITAL

Introduction Ileocecal resection is the most frequently performed surgical procedure in patients with abdominal Crohn's disease (CD), and various techniques and anastomosis configurations (end-to-end, side-to-side, end-to-side, among others) are used, depending on the surgeon's preference and the access route (laparotomy, laparoscopy, or robotic platform). Recurrence occurs at or near the anastomosis site. In 2011, Kono and colleagues in Japan described a new technique for a wide, anti-mesenteric anastomosis with the goal of reducing surgical recurrence.

Objective To describe in detail the Kono-S technique and present the initial experience and results observed at a tertiary university hospital.

Methods The technique involves the release of the ileum and ascending colon via laparoscopy, followed by a median supra- and infra-umbilical incision approximately 10 cm in length, with exteriorization of the ileocecal segment and subsequent resection of the diseased area. A support column is then created by approximating the stapled segments to prevent twisting of the anastomosis. After suturing and approximating the two stumps, two enterotomies are made—one in the ileum and the other in the colon—7 to 8 cm in length, on the anti-mesenteric border, approximately 1 cm from the support column. Finally, an anti-mesenteric end-to-end manual anastomosis is performed with absorbable 000 sutures. A video detailing the technical steps and materials used will be presented.

Results From February 2022 to November 2023, six patients with ileocecal CD underwent the Kono-S procedure, with four females (66.6%) and a median age of 35 years (range 22 to 63 years). Colon preparation was performed in 4 patients, and therapeutic antibiotics were administered to all patients, along with peritoneal cavity drainage. No patients required reoperation, and there were no deaths. The average hospital stay was 11 days (range 6 to 19 days). All patients are undergoing recurrence prophylaxis (three with anti-TNF, two with vedolizumab, and one with ustekinumab). No recurrence was observed after a median follow-up of 17 months (range 7 to 25 months).

Conclusion Our study concluded that the Kono-S technique is safe and may benefit recurrence rates, although the follow-up period is short. Multicenter global randomized studies with long-term follow-up are needed to validate this technique.

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Artikel online veröffentlicht:
25. April 2025