Purpose The role of Kono-S and extent of mesenteric excision in reducing the risk of Crohn's disease recurrence remains unclear in the surgical literature. Clinical trials and meta-analyses have not provided direct comparison of all four approaches. This is a comprehensive network meta-analysis comparing Kono-S and standard anastomosis with limited and extended mesenteric excision. Methodology A comprehensive database search was performed and studies were included if they compared either Kono-S, standard anastomosis, extended mesenteric excision (EME) or limited mesenteric excision (LME) in the setting of Crohn’s disease, where disease recurrence was a primary end point. Primary outcomes were endoscopic recurrence (ER) within 18 months and 5 years. Secondary outcomes were surgical recurrence (SR) at 5 years and clinical recurrence (CR) at 1 year. Results Kono-S had significantly lower surgical recurrence at 5 years compared to other anastomosis (OR 0.1; 95% CI 0.04 – 0.25; p < 0.00001) but no difference in ER <18 months was observed (OR 0.84; 95% CI 0.62 – 1.14; p = 0.26) or CR at 12 months (OR 0.81; 95% CI 0.39 – 1.68; p = 0.57). When compared to LME, EME had no difference in ER < 18 months (OR 1.07; 95% CI 0.73 – 1.56; p = 0.72) or SR at 5 years (OR 0.87; 95% CI 0.47 – 1.6; p = 0.65). Conclusion There may be a trend for decreased surgical recurrence of Crohn’s disease at 5 years with Kono-S compared to other anastomotic configurations. There is no difference between LME or EME in the published data. Randomised trials on both Kono-S and EME are currently underway, with the results eagerly awaited.