Fig. 1.

Surgical technique of Kono-S anastomosis. a The nearby mesentery of the ileocecal region that is to be excised is divided at the mesenteric wall of the bowel. The dotted line indicates the resection lines. b The intestine is transected by use of a linear staple cutter such that the mesentery is in the middle of the staple line and at a 90° angle to it. c Then, the staple lines are sutured together transversely to create a supporting column that is supposed to support the eventual dimension of the anastomosis. d Longitudinal enterotomies of 7 cm length are then performed at the antimesenteric aspect, beginning 1 cm from the supporting column. e The anastomosis is then created transversely in hand-sewn fashion. The backwall using a double-layer continuous manner, the front wall using a single-layered continuous suture. All sutures with 4/0 PDS. f The pale lines indicate the mesenteric side below the anastomosis with the supporting column that is created with the proximal and distal bowel stumps