Abstract
<title>Abstract</title> <p>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 to 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 median length of stay (5.1 vs. 7.3 days; p = 0.001) and reduced ileostomy formation (8.8% vs. 44.4%; p = 0.002) compared to the conventional group. There was no increase in operation time, and the Kono-S group recorded zero anastomotic leaks and zero Clavien-Dindo Grade III or higher complications. Multivariable logistic regression for 12-month endoscopic recurrence identified postoperative biologic use as the only significant protective factor (OR 0.08; p = 0.025), while the Kono-S technique did not demonstrate a statistically significant impact on recurrence (OR 0.44; p = 0.35) Conclusion The Kono-S technique is highly safe and feasible, offering excellent short-term perioperative outcomes including reduced length of stay and lower rates of defunctioning stomas. Early recurrence rates appear comparable to conventional approaches, heavily modulated by postoperative biologic therapy.</p>