Crohn’s disease is a condition that can be treated with medication, and although disease management is often improved with new-generation drugs, surgery may be necessary in cases of unresponsiveness to medication, intestinal blockage, perforation, fistula, severe bleeding, toxic colitis, or the development of cancer.
In Crohn’s surgery, different surgical approaches may be applied, taking into account the patient’s overall health, conditions for performing the surgery, and characteristics of the intestinal tissue. While surgery to widen a narrowed section of the intestine, known as strictureplasty, may be appropriate for some patients, the majority typically undergo resection, which involves cutting out the diseased portion of the intestine.
After the removal of the affected intestinal segment in Crohn’s surgery, the surgeon’s preference, depending on the disease and the patient’s condition, may involve directly reconnecting the remaining intestines or creating a temporary stoma followed by a second surgery to reconnect the intestines.
One common issue after Crohn’s surgery is the narrowing of the intestinal anastomosis line, known as anastomotic stricture. To prevent this, various methods have been tried, with Kono-S anastomosis currently standing out as the most effective. This technique, described by Japanese surgeon Kono in 2011, is technically more challenging than traditional methods, but it has attracted the attention of many colorectal surgeons performing Crohn’s surgery. Comparative studies have shown similar surgical risks in the short term, but in the long term, the incidence of anastomotic stricture and recurrence is significantly lower in patients who undergo Kono-S anastomosis. The lower recurrence of anastomotic issues also leads to a reduction in the need for reoperations in Crohn’s patients.
In the Kono-S surgery, the Crohn’s-diseased intestine is cut and removed using special surgical stapling systems called staplers. Two intestine pieces with stapled ends are left behind. Longitudinal incisions are made on both sides of the intestine, parallel to the spine, at a horizontal width of 7-8 cm, away from the intestinal vessels. The intestines are then sutured together by bringing the stapled lines of the intestines into contact. The incisions made on the back side are stitched together with absorbable sutures, forming a single layer near the stapler and a double layer on the front side. This ensures an anastomosis is created from the furthest possible point, avoiding contact with the mesentery, which some researchers consider a source of Crohn’s disease.
Crohn’s disease surgery can be performed as an open, laparoscopic, or robotic procedure. The specialized and challenging Kono-S anastomosis can be conducted manually through the incision where the intestinal piece is removed during closed surgeries, or it can be performed robotically.
This technique, which does not require special postoperative care, allows the patient to be discharged after completing standard treatment and follow-up processes. After the healing process is complete, the patient continues follow-up with a gastroenterology specialist.
