Crohn's Disease: advantages of the Konos-S surgical technique




Chron's Disease; Surgical technique; Konos- S; Health teaching.


Introduction: Crohn's Disease (CD) belongs to the group of diseases called Inflammatory Bowel Diseases (IBD). CD is an inflammatory disease characterized by idiopathic, local and chronic nonspecific inflammation, currently the real cause is still unknown. The recurrence of anastomosis after intestinal resection is one of the most significant problems in the management of CD, recently a new surgical technique was described and used to reduce recurrence, the Konos-S technique described by Konos et al. (2011). Objective: To carry out a systematic review of the literature to describe Crohn's disease and the use of the Konos-S surgical technique for the treatment of the disease. Methodology: This study is a systematic review of the literature on the main search platforms for scientific articles: ScienceDirect, PubMed, SciELO, BIREME, from 2011 to 2022, 18 articles were selected. Results and Discussion: Kono and colleagues introduced into surgery their unique surgical technique to reduce the risk of surgical recurrence of the anastomosis is a hand-stitched end-to-end functional antimesenteric anastomosis. Some clinical studies have demonstrated the effectiveness of the technique in significantly reducing anastomotic and endoscopic recurrence, as it is able to preserve innervation and blood supply, important factors for proper healing of the anastomosis, with a lower risk of reoperation. However, more research is needed to universally validate Konos-S surgery for patients with an indication, as the treatment approach must be personalized for CD cases and complications must be analyzed individually for the patient.


Actis, G. C., Pellicano, R., Fagoonee, S., & Ribaldone, D. G. (2019). History of inflammatory bowel diseases. Journal of clinical medicine, 8(11), 1970.

Adamina, M., Bonovas, S., Raine, T., Spinelli, A., Warusavitarne, J., Armuzzi, A., & Zmora, O. (2020). ECCO guidelines on therapeutics in Crohn’s disease: surgical treatment. Journal of Crohn's and Colitis, 14(2), 155-168.

Alshantti, A., Hind, D., Hancock, L., & Brown, S. R. (2021). The role of Kono‐S anastomosis and mesenteric resection in reducing recurrence after surgery for Crohn’s disease: a systematic review. Colorectal Disease, 23(1), 7-17.

Anbazhagan, A. N., Priyamvada, S., Alrefai, W. A., & Dudeja, P. K. (2018). Pathophysiology of IBD associated diarrhea. Tissue barriers, 6(2), e1463897.

Aniwan, S., & Loftus, E. V. (2021). The Natural History of Inflammatory Bowel Disease. Current Treatment Options in Gastroenterology, 1-11.

Atreya, R., & Siegmund, B. (2021). Location is important: differentiation between ileal and colonic Crohn’s disease. Nature Reviews Gastroenterology & Hepatology, 18(8), 544-558.

Bislenghi, G., Devriendt, S., Wolthuis, A., & D’Hoore, A. (2022). Totally stapled Kono-S anastomosis for Crohn’s disease. Techniques in Coloproctology, 1-4.

Chang, J. T. (2020). Pathophysiology of inflammatory bowel diseases. New England Journal of Medicine, 383(27), 2652-2664.

Coffey, C. J., Kiernan, M. G., Sahebally, S. M., Jarrar, A., Burke, J. P., Kiely, P. A., & Dunne, C. P. (2018). Inclusion of the mesentery in ileocolic resection for Crohn’s disease is associated with reduced surgical recurrence. Journal of Crohn's and Colitis, 12(10), 1139-1150.

Cushing, K., & Higgins, P. D. (2021). Management of Crohn disease: a review. Jama, 325(1), 69-80.

Fichera, A., Zoccali, M., & Kono, T. (2012). Antimesenteric functional end-to-end handsewn (Kono-S) anastomosis. Journal of gastrointestinal surgery, 16(7), 1412-1416.

Fragoulis, G. E., Liava, C., Daoussis, D., Akriviadis, E., Garyfallos, A., & Dimitroulas, T. (2019). Inflammatory bowel diseases and spondyloarthropathies: from pathogenesis to treatment. World journal of gastroenterology, 25(18), 2162.

Gajendran, M., Loganathan, P., Catinella, A. P., & Hashash, J. G. (2018). A comprehensive review and update on Crohn's disease. Disease-a-month, 64(2), 20-57.

Germer, C. T, & Reibetanz, J. (2020). Anastomose Kono-S vs. anastomose ileocólica lado a lado com grampo no contexto da ressecção ileocecal na doença de Crohn. The Surgeon ,

Katsuno, H., Maeda, K., Hanai, T., Masumori, K., Koide, Y., & Kono, T. (2015). Novel antimesenteric functional end-to-end handsewn (Kono-S) anastomoses for Crohn's disease: a report of surgical procedure and short-term outcomes. Digestive surgery, 32(1), 39-44.

Kellil, T., Chaouch, M. A., Guedich, A., Touir, W., Dziri, C., & Zouari, K. (2021). Surgical features to reduce anastomotic recurrence of Crohn’s disease that requires reoperation: a systematic review. Surgery Today, 1-8.

Kono, T., & Fichera, A. (2020). Surgical Treatment for Crohn's Disease: A Role of Kono-S Anastomosis in the West. Clinics in colon and rectal surgery, 33(06), 335-343.

Kono, T., Ashida, T., Ebisawa, Y., Chisato, N., Okamoto, K., Katsuno, H., ... & Furukawa, H. (2011). A new antimesenteric functional end-to-end handsewn anastomosis: surgical prevention of anastomotic recurrence in Crohn's disease. Diseases of the colon & rectum, 54(5), 586-592.

Kono, T., Fichera, A., Maeda, K., Sakai, Y., Ohge, H., Krane, M., ... & Fujiya, M. (2016). Kono-S anastomosis for surgical prophylaxis of anastomotic recurrence in Crohn’s disease: an international multicenter study. Journal of Gastrointestinal Surgery, 20(4), 783-790.

Lightner, A. L., Vogel, J. D., Carmichael, J. C., Keller, D. S., Shah, S. A., Mahadevan, U., & Feingold, D. L. (2020). The American society of colon and rectal surgeons clinical practice guidelines for the surgical management of Crohn’s disease. Diseases of the Colon & Rectum, 63(8), 1028-1052.

Luglio, G., & Kono, T. (2021). Surgical Techniques and risk of postoperative recurrence in CD: a game changer? Inflammatory Intestinal Diseases, 1-7.

Luglio, G., Rispo, A., Imperatore, N., Giglio, M. C., Amendola, A., Tropeano, F. P., & Bucci, L. (2020). Surgical prevention of anastomotic recurrence by excluding mesentery in Crohn's disease: the SuPREMe-CD study-a randomized clinical trial. Annals of surgery, 272(2), 210-217.

Luglio, G., Tropeano, F. P., Amendola, A., Rispo, A., Castiglione, F., Bucci, L., & De Palma, G. D. (2020). Preventing recurrence in Crohn’s disease: the Kono-S anastomosis with two-layer technique. Techniques in Coloproctology, 24(11), 1213-1214.b

Ng, C. H., Chin, Y. H., Lin, S. Y., Koh, J. W. H., Lieske, B., Koh, F. H. X., & Foo, F. J. (2021). Kono-S anastomosis for Crohn’s disease: a systemic review, meta-analysis, and meta-regression. Surgery Today, 51(4), 493-501.

Peltrini, R., Greco, P. A., Manfreda, A., Luglio, G., & Bucci, L. (2020). Kono-S anastomosis after intestinal resection for Crohn’s disease. Updates in Surgery, 72(2), 335-340.

Pereira, A. S., Shitsuka, D. M., Parreira, F. J., & Shitsuka, R. (2018). Metodologia da pesquisa científica.

Ramos, G. P., & Papadakis, K. A. (2019, January). Mechanisms of disease: inflammatory bowel diseases. In Mayo Clinic Proceedings (Vol. 94, No. 1, pp. 155-165). Elsevier.

Reynolds, I. S., Doogan, K. L., Ryan, É. J., Hechtl, D., Lecot, F. P., Arya, S., & Martin, S. T. (2021). Surgical Strategies to Reduce Postoperative Recurrence of Crohn's Disease After Ileocolic Resection. Frontiers in Surgery, 8.

Roda, G., Chien Ng, S., Kotze, P. G., Argollo, M., Panaccione, R., Spinelli, A., & Danese, S. (2020). Crohn’s disease. Nature Reviews Disease Primers, 6(1), 1-19.

Rubin, D. T., Abreu, M. T., Rai, V., Siegel, C. A., Ahuja, V., Allez, M., & Ungaro, R. (2020). Management of patients with Crohn’s disease and ulcerative colitis during the coronavirus disease-2019 pandemic: results of an international meeting. Gastroenterology, 159(1), 6-13.

Shimada, N., Ohge, H., Kono, T., Sugitani, A., Yano, R., Watadani, Y., & Sueda, T. (2019). Surgical recurrence at anastomotic site after bowel resection in Crohn’s disease: comparison of Kono-S and end-to-end anastomosis. Journal of Gastrointestinal Surgery, 23(2), 312-319.

Van Rheenen, P. F., Aloi, M., Assa, A., Bronsky, J., Escher, J. C., Fagerberg, U. L., & Ruemmele, F. M. (2021). The medical management of paediatric Crohn’s disease: an ECCO-ESPGHAN guideline update. Journal of Crohn's and Colitis, 15(2), 171-194.

Veauthier, B., & Hornecker, J. R. (2018). Crohn's disease: diagnosis and management. American family physician, 98(11), 661-669.




How to Cite

ALVES, M. G. R.; AFONSO, I. F. .; ARAUJO, A. . L. C. N. de; RODRIGUES , . B. V. .; NOGUEIRA, K. de M.; SANTOS, L. G. dos .; CARVALHO , R. K. P.; ARCANJO, C. P. C. . Crohn’s Disease: advantages of the Konos-S surgical technique. Research, Society and Development, [S. l.], v. 11, n. 6, p. e7911628803, 2022. DOI: 10.33448/rsd-v11i6.28803. Disponível em: Acesso em: 18 may. 2022.



Health Sciences