{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T01:36:54Z","timestamp":1780105014363,"version":"3.54.0"},"reference-count":16,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T00:00:00Z","timestamp":1760918400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: The Kono-S anastomosis is a bowel-sparing surgical technique developed to reduce postoperative recurrence in Crohn\u2019s 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.<\/jats:p>","DOI":"10.3390\/jcm14207403","type":"journal-article","created":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T13:54:41Z","timestamp":1760968481000},"page":"7403","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Kono-S Anastomosis in Pediatric Crohn\u2019s Disease: Experience at a Tertiary Referral Center"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3328-0734","authenticated-orcid":false,"given":"Valeria","family":"Dipasquale","sequence":"first","affiliation":[{"name":"Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood \u201cG. Barresi\u201d, University Hospital \u201cG. Martino\u201d, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8827-2091","authenticated-orcid":false,"given":"Claudio","family":"Romano","sequence":"additional","affiliation":[{"name":"Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood \u201cG. Barresi\u201d, University Hospital \u201cG. Martino\u201d, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7616-5480","authenticated-orcid":false,"given":"Carmelo","family":"Romeo","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Unit, Department of Human Pathology in Adulthood and Childhood \u201cG. Barresi\u201d, University Hospital \u201cG. Martino\u201d, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4262-2433","authenticated-orcid":false,"given":"Pietro","family":"Impellizzeri","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Unit, Department of Human Pathology in Adulthood and Childhood \u201cG. Barresi\u201d, University Hospital \u201cG. Martino\u201d, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela Simona","family":"Montalto","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Unit, Department of Human Pathology in Adulthood and Childhood \u201cG. Barresi\u201d, University Hospital \u201cG. Martino\u201d, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Navarra","sequence":"additional","affiliation":[{"name":"Surgical Oncology Division, Department of Human Pathology in Adulthood and Childhood \u201cG. Barresi\u201d, University Hospital \u201cG. Martino\u201d, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1007\/DCR.0b013e318208b90f","article-title":"A new antimesenteric functional end-to-end handsewn anastomosis: Surgical prevention of anastomotic recurrence in Crohn\u2019s disease","volume":"54","author":"Kono","year":"2011","journal-title":"Dis. Colon Rectum"},{"key":"ref_2","first-page":"671","article-title":"Meta-analysis of the Kono-S anastomosis versus conventional anastomoses in Crohn\u2019s disease","volume":"26","author":"Shimoyama","year":"2022","journal-title":"J. Gastrointest. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1097\/SLA.0000000000003821","article-title":"Surgical prevention of anastomotic recurrence by excluding mesentery in Crohn\u2019s disease: The SuPREMe-CD study\u2014A randomized clinical trial","volume":"272","author":"Luglio","year":"2020","journal-title":"Ann. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1007\/s00595-020-02130-3","article-title":"Kono-S anastomosis for Crohn\u2019s disease: A systemic review, meta-analysis, and meta-regression","volume":"51","author":"Ng","year":"2021","journal-title":"Surg. Today"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1093\/ecco-jcc\/jjad176","article-title":"Does Kono-S anastomosis reduce recurrence in Crohn\u2019s disease compared with conventional ileocolonic anastomosis? A nationwide propensity score-matched study from GETAID Chirurgie Group [KoCoRICCO Study]","volume":"18","author":"Alibert","year":"2024","journal-title":"J. Crohns Colitis"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1007\/s00383-023-05572-1","article-title":"Use of the Kono-S anastomosis in pediatric Crohn\u2019s disease: A single-institution experience","volume":"39","author":"Obi","year":"2023","journal-title":"Pediatr. Surg. Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1007\/s00383-024-05648-6","article-title":"Kono-S anastomosis in Crohn\u2019s disease: Initial experience in pediatric patients","volume":"40","author":"Dotlacil","year":"2024","journal-title":"Pediatr. Surg. Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1016\/j.crohns.2014.04.005","article-title":"Consensus guidelines of ECCO\/ESPGHAN on the medical management of pediatric Crohn\u2019s disease","volume":"8","author":"Ruemmele","year":"2014","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"14","DOI":"10.5223\/pghn.2017.20.1.14","article-title":"Surgery in pediatric Crohn\u2019s disease: Indications, timing and post-operative management","volume":"20","author":"Kim","year":"2017","journal-title":"Pediatr. Gastroenterol. Hepatol. Nutr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1097\/MPG.0000000000000239","article-title":"European Society of Pediatric Gastroenterology, Hepatology, and Nutrition. ESPGHAN revised Porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents","volume":"58","author":"Levine","year":"2014","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1007\/s40272-024-00650-w","article-title":"Preventing recurrence of Crohn\u2019s disease post-ileocaecal surgery in paediatric patients: A therapy guide based on systematic review of the evidence","volume":"26","author":"Bronsky","year":"2024","journal-title":"Paediatr. Drugs"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1016\/0016-5085(90)90613-6","article-title":"Predictability of the postoperative course of Crohn\u2019s disease","volume":"99","author":"Rutgeerts","year":"1990","journal-title":"Gastroenterology"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Dipasquale, V., Milone, E., Nigro, S., Alibrandi, A., Antonelli, E., Di Fabrizio, D., Romeo, C., Navarra, G., and Romano, C. (2024). Risk factors for complications and disease recurrence after ileocecal resection for Crohn\u2019s disease in children and adults. Biomedicines, 12.","DOI":"10.3390\/biomedicines12040862"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1111\/codi.16914","article-title":"A new surgical technique: Robotic intracorporeal Kono-S anastomosis in Crohn\u2019s\u2014A safety and feasibility case series on short-term outcomes","volume":"26","author":"Smalbroek","year":"2024","journal-title":"Colorectal Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1093\/ecco-jcc\/jjx187","article-title":"Inclusion of the mesentery in ileocolic resection for Crohn\u2019s disease is associated with reduced surgical recurrence","volume":"12","author":"Coffey","year":"2018","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1093\/ecco-jcc\/jjz083","article-title":"Hypoalbuminaemia and postoperative outcomes in inflammatory bowel disease: The NSQIP Surgical Cohort","volume":"13","author":"Nguyen","year":"2019","journal-title":"J. Crohn\u2019s Colitis"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/20\/7403\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T14:18:09Z","timestamp":1760969889000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/20\/7403"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,20]]},"references-count":16,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["jcm14207403"],"URL":"https:\/\/doi.org\/10.3390\/jcm14207403","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,20]]}}}