WOFAPS 2025 8th World Congress of Pediatric Surgery

Victoria Glushkova, Alexey Podkamenev, Sergey Peredereev

Saint Petersburg State Pediatric Medical University

Background. Resection of the ileocecal zone is the most common surgical procedure in children with complicated forms of Crohn's disease. The configuration of the anastomosis and the method of its formation can affect the local recurrence of the disease.

Aim To evaluate the first results of performing Kono-S anastomosis in pediatric patients with Crohn's disease in Russia.

Materials and methods. From 2017 to 2025, 63 ileocecal resections were performed in children with complicated forms of Crohn's disease, of which 7 (11%) patients had Kono - S anastomosis formed (the boundaries of intestinal resection were crossed using a suturing device, a supporting column was formed, enterotomy along the antimesenteric edge of 7 cm followed by transverse suturing of the intestinal wall with a continuous manual suture). The median age at surgery was was 15 years. The operation time was 176.43 ± 35.91 min. After the surgery, all children received anti-relapse treatment including anti-TNF drugs.

Result The early results showed the safety of this type of anastomosis, there was no postoperative ileus or other complications according to the Clavien-Dindo scale for 30 days. After 6 months, all patients underwent a control endoscopic examination. According to the Rutgers scale, changes in the anastomotic area did not exceed i2a values, which corresponds to endoscopic remission, and there were no signs of clinical relapse of the disease.

Conclusion. Kono-S anastomosis combines manual and mechanical suture techniques and is more complex than traditional anastomosis. Its wide diameter, isoperistaltic orientation, and supporting column create the prerequisites for reducing the risk of local relapse, but randomized studies are needed to determine long-term results in pediatric patients with Crohn's disease and Kono-S anastomosis.