title: Antimesenteric functional end-to-end handsewn (Kono-S) anastomosis.
abstract: BACKGROUND
  Anastomotic recurrence is a frequent event after bowel resection for Crohn's disease. To date, no anastomotic technique has been proven to be superior in reducing surgical recurrence rates in this setting. In this article, we describe our technique in performing a new antimesenteric functional end-to-end handsewn (Kono-S) anastomosis.
  
  
  METHODS
  The segment of bowel to be resected is identified and mobilized. The bowel is then divided transversely with a linear stapler-cutter device. The intervening mesentery is divided close to the bowel. The corners of the two stapled lines are sutured together, and the two stapled lines are approximated with interrupted sutures. An antimesenteric longitudinal enterotomy is performed on both sides, starting no more than 1 cm away from the staple line, to allow a transverse lumen of 7-8 cm. The openings are closed transversely in two layers.
  
  
  RESULTS
  From May 1, 2010 to July 31, 2011 we performed 46 Kono-S anastomoses. One patient had a contained anastomotic leak successfully treated conservatively. Currently, 18 patients (43 %) have undergone follow-up endoscopic surveillance with an average Rutgeert's score of 0.7 (0-3) at a mean of 6.8 months.
  
  
  CONCLUSIONS
  The Kono-S anastomosis is a safe anastomotic technique. Long-term studies are needed to confirm its efficacy in preventing surgical recurrence.
authors.affiliation: Department of Surgery, University of Chicago Medical Center, 5841 S. Maryland Avenue, MC 5095, Chicago, IL 60637, USA. afichera@surgery.bsd.uchicago.edu
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fichera
authors.forename: Marco
authors.initials: M
authors.lastname: Zoccali
authors.forename: Toru
authors.initials: T
authors.lastname: Kono
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D003424:Crohn Disease / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007422:Intestines / Q000601:surgery*; D008297:Male; D008643:Mesentery / Q000601:surgery*; D008875:Middle Aged; D013536:Suture Techniques; D016896:Treatment Outcome; D055815:Young Adult