Safety, feasibility and perioperative outcomes of Kono-S anastomosis in Crohn’s disease patients: a multi-centred South Australian experience

Purpose The Kono-S anastomosis, a modified hand-sewn technique, aims to minimize postoperative recurrence in Crohn’s disease (CD). While early studies suggest potential benefits, real-world data regarding its safety, feasibility and immediate perioperative outcomes during the early adoption phase remain essential. This study aims to assess the short-term perioperative efficacy and safety profile of the Kono-S anastomosis compared with conventional techniques in patients undergoing ileocaecal resection for CD. Methods A retrospective multi-centre study was performed including patients with CD who underwent ileocecal resection between 1 January 2020 and 1 February 2025. Disease recurrence was evaluated as the primary endpoint and perioperative safety, including length of stay, complication rates and stoma formation were secondary endpoints. Results Seventy patients were included (34 patients in Kono-S, 36 patients in Conventional group). The Kono-S group demonstrated a significantly shorter mean length of stay (5.1 versus 7.3 days; p = 0.001) and reduced ileostomy formation (8.8% versus 44.4%; p = 0.002) compared with the conventional group. There was no increase in operation time, and the Kono-S group recorded zero anastomotic leaks and Clavien–Dindo Grade III or higher complications. Exploratory multivariable analysis indicated that postoperative biologic therapy was the sole independent predictor of reduced 12-month endoscopic recurrence (OR 0.08, p = 0.025), whereas the Kono-S technique itself was not statistically associated with a recurrence benefit (OR 0.44, p = 0.35). Conclusions The Kono-S technique is highly safe and feasible, offering favourable short-term perioperative outcomes, including reduced length of stay and lower rates of defunctioning stomas, though this is heavily influenced by patient selection in the elective setting. Early recurrence rates appear comparable to conventional approaches, heavily modulated by postoperative biologic therapy.