VM81 - Robotic Kono-S for Jejunal Stricture with Retained Pill Camera

Purpose/Background: This video presents a 39 year old male with retained pill camera and jejunal stricture 5 years after initial work up for iron deficiency anemia. He was diagnosed with fibrostenosing Crohn’s disease. He required a small bowel resection and robotic Kono-S anastomosis was selected for his reconstruction. This video shows how to perform a Robotic Kono-s anastomosis on a jejunal stricture.

Methods/Interventions: The jejunal stricture was resected using standard linear stapler technique. The support column was created by alining the two ends of bowel and placing interrupted sutures. 6 cm longitudinal enterotomies were created using hot scissors. Pulley sutures were placed superiorly and inferiorly. This retraction allowed for a fish like appearance of the enterotomies. The shape of the fish mouth and the pulley sutures helped the anastomosis line up. The anastomosis was performed in two layers. A running suture was placed in the middle and ran inferiorly. A second suture was placed in the middle and ran superiorly. Both sutures were ran around the corners and then back to midline to complete the anastomosis. The second layer was placed in a running Lembert fashion. The mesentery was closed in a running fashion.

Results/Outcomes: The patient had return of bowel function post op day two and was discharged home.

Conclusion/Discussion: This video demonstrates a robotic Kono-S anastomosis for jejunal stricture. This minimally invasive technique allows for better pain control, faster recovery, and shorter length of stay.