Antimesenteric functional end-to-end handsewn (Kono-S) anastomosis

Anastomotic recurrence is a frequent event after bowel resection for Crohn's disease. To date, no anastomotic technique has been proven to be superior in reducing surgical recurrence rates in this setting. In this article, we describe our technique in performing a new antimesenteric functional end-to-end handsewn (Kono-S) anastomosis.

The segment of bowel to be resected is identified and mobilized. The bowel is then divided transversely with a linear stapler-cutter device. The intervening mesentery is divided close to the bowel. The corners of the two stapled lines are sutured together, and the two stapled lines are approximated with interrupted sutures. An antimesenteric longitudinal enterotomy is performed on both sides, starting no more than 1 cm away from the staple line, to allow a transverse lumen of 7-8 cm. The openings are closed transversely in two layers.

From May 1, 2010 to July 31, 2011 we performed 46 Kono-S anastomoses. One patient had a contained anastomotic leak successfully treated conservatively. Currently, 18 patients (43 %) have undergone follow-up endoscopic surveillance with an average Rutgeert's score of 0.7 (0-3) at a mean of 6.8 months.

The Kono-S anastomosis is a safe anastomotic technique. Long-term studies are needed to confirm its efficacy in preventing surgical recurrence.