Kono-S Anastomosis in Pediatric Crohn’s Disease: Experience at a Tertiary Referral Center

<b>Objectives:</b> The Kono-S anastomosis is a bowel-sparing surgical technique developed to reduce postoperative recurrence in Crohn's 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. <b>Methods:</b> 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. <b>Results:</b> 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. <b>Conclusions:</b> 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.