Is stapled Kono-S anastomosis a protective factor against postoperative endoscopic recurrence in Crohn's disease? a single-center, retrospective cohort study

Background: Hand-sewn Kono-S anastomosis is safe and associated with a reduction in post-operative recurrence (POR) in Crohn's disease (CD). The study aims to investigate the advantages of stapled Kono-S in Crohn's patients with intestinal anastomosis.

Methods: Crohn's patients undergoing intestinal anastomosis were reviewed via a prospectively maintained database. Patients with conventional stapled side-to-side anastomosis were classified as the conventional group and those received stapled Kono-S anastomosis were identified as the Kono-S group. The primary endpoint was modified endoscopic recurrence (mER, ≥i2b). Other endpoints were ER (≥i2), severe ER (i3 & i4), intra- and postoperative outcomes including morbidity and hospital stay, and cross-sectional parameters. Multivariable logistic analysis was performed to assess independent risks for mER.

Results: From 2020 to 2023, totally 199 patients (63 in the Kono-S group) were included. After matching, with 63 patients in each group, the overall rates of mER, ER and severe ER were 19.0%, 24.6% and 8.7%, respectively. The rates of mER, ER and severe ER were lower in the Kono-S group than those of the conventional group (12.7% vs. 25.4%, p=0.07; 20.6% vs. 28.6%, p=0.30; 6.3% vs. 11.1%, p=0.34). Multivariate analysis indicated stapled Kono-S (OR=0.35; 95% CI: 0.12-0.98, p=0.047) was independent protective factor for mER, while male gender (OR=7.75; 95% CI: 1.5-40.0, p=0.01) and BMI<18.5 (OR=3.27; 95%CI: 1.11-9.67, p=0.03) were the independent risk factors for mER.

Conclusions: Stapled Kono-S anastomosis is safe for CD but may not be a protective factor against POR compared to conventional stapled side-to-side anastomosis.