Kono-S or side-to-side anastomosis for resection in Crohn’s terminal ileitis?

After 12 to 18 months of follow-up after resection for Crohn’s terminal ileitis, Kono-S anastomosis and side-to-side functional end anastomosis yielded similar outcomes with respect to endoscopic recurrence rates. These results were independent of anastomotic configuration or the use of biologics.

A multicentre, international study randomised 364 participants with primary Crohn’s terminal ileitis who required resection 1:1 to Kono-S anastomosis or to side-to-side functional end anastomosis. Dr Koianka Trencheva (Cornell University, NY, USA) and colleagues looked primarily at endoscopic recurrence rates using the modified Rutgeerts score [1]. “Prophylactic treatment with biologics was not allowed until the first colonoscopy at 3–6 months,” Dr Trencheva explained the research protocol. “In case of symptoms, however, treatment could be started at the discretion of the gastroenterologist.”

After 12 to 18 months of follow-up, the endoscopic recurrence rate was 31.5% in the Kono-S arm and 34.3% in the side-to-side arm, reflecting a non-significant difference (P=0.68). The corresponding rates in biologic-experienced participants (n=118) were 28.3% and 37.9% (P=0.33). For biologic-naïve participants (n=117) these rates were 34.3% and 30.0% (P=0.69). Finally, participants with penetrating/fistulating B3 disease had an increased risk of endoscopic recurrence (OR 4.14; 95% CI 1.12–15.32; P=0.034).

This randomised trial does not confirm that Kono-S anastomosis leads to lower endoscopic recurrence rates than side-to-side functional end anastomosis among patients with Crohn’s terminal ileitis who require resection.

1. Trencheva K, et al. Endoscopic recurrence after resection of Crohn’s terminal ileitis with Kono-S or side-to-side functional end anastomosis: 12-18 months results from multicenter prospective randomized trial. OP16, 20th Congress of ECCO, 19–22 February 2025, Berlin, Germany.

Copyright ©2025 Medicom Medical Publishers



Posted on 8 April 20258 April 2025