Kono-S anastomosis

To perform a Kono-S anastomosis, bowel resection is carried out with GIA staplers placed perpendicular to the mesentery (A). The bowel stumps are first reinforced with absorbable sutures, then sutured together to create a common support column, a unique feature of this technique (B). Bowels on both sides of the center support column are then opened longitudinally at the antimesenteric border, starting at 1 cm from the support column (C). The longitudinal incisions are then hand-sewn closed transversely using absorbable sutures in a single-layer manner to complete the anastomosis (D). In the completed anastomosis, the support column is positioned between the anastomosis and the mesentery (E). The potential advantage of the support column is to maintain the diameter and dimension of the anastomosis and prevent distortion or stenosis associated with recurrent strictures, which usually starts from the mesenteric side.