# Kono-S Anastomosis in Pediatric Crohn’s Disease: Experience at a Tertiary Referral Center

## TL;DR

This study examines the safety and effectiveness of the Kono-S anastomosis in children with Crohn's disease at a specialized hospital.

## Contribution

The study presents the first Italian pediatric case series on the Kono-S anastomosis for Crohn's disease.

## Key findings

- Eleven pediatric patients underwent Kono-S anastomosis with no postoperative complications.
- Follow-up endoscopy showed low endoscopic recurrence in most patients.
- All patients started anti-TNF-alpha therapy within 10.4 weeks post-surgery.

## Abstract

Objectives: The Kono-S anastomosis is a bowel-sparing surgical technique developed to reduce postoperative recurrence in Crohn’s disease (CD). While its efficacy has been established in adults, data in pediatric populations remain scarce. This study aims to evaluate the safety, feasibility, and early outcomes of the Kono-S technique in children and adolescents with CD at a single tertiary referral center. Methods: A retrospective review was conducted of pediatric CD patients who underwent bowel resection with Kono-S anastomosis between January 2022 and March 2025. Data collected included patient demographics, surgical indications, intraoperative findings, postoperative complications, and follow-up, including endoscopic surveillance. Results: Eleven patients (median age 14.7 years; 63.6% female) underwent laparoscopic Kono-S anastomosis, primarily ileocolic. Indications included stricturing disease (n = 6), intra-abdominal abscesses (n = 3), or both (n = 2). No postoperative complications occurred. Median follow-up was 21 months. Follow-up endoscopy was performed in nine patients: eight had a Rutgeerts score of 0, and one had a score of 1. All patients began anti-TNF-alpha therapy within a median of 10.4 weeks post-surgery. Conclusions: This first Italian pediatric case series suggests that Kono-S anastomosis may be safe and feasible in CD, with low early endoscopic recurrence. Larger, multicenter studies with long-term follow-up are needed to validate these findings.