Since the publication of the SuPREMe-CD [1] randomised controlled study comparing the Kono S anastomosis with the stapled side to side anastomosis, after ileocolic resection for Crohn’s disease, many surgeons will have considered that there is sufficient evidence to implement this new technique into their practice. It is important to recognise that this study used the Rutgeerts score as a surrogate for clinical and surgical outcomes and updated data is now available and was presented at ECCO. Additionally, the interim results of the New York multicentre RCT, powered with a much greater sample size, raise questions regarding even these surrogate outcomes. Furthermore the SPICY trial [2] evaluating the extent of mesenteric resection has concluded and these early results are interesting. Crohn’s disease patients are a heterogenous cohort and randomised studies are paramount to evaluate new surgical techniques in a scientific and methodical fashion. [3] References 1.Luglio, G., et al., Surgical Prevention of Anastomotic Recurrence by Excluding Mesentery in Crohnʼs Disease: The SuPREMe-CD Study - A Randomized Clinical Trial. Ann Surg, 2020. 272(2): p. 210-217. 2.van der Does de Willebois, E.M.L., Mesenteric SParIng versus extensive mesentereCtomY in primary ileocolic resection for ileocaecal Crohn's disease (SPICY): study protocol for randomized controlled trial. BJS Open, 2022. 6(1). 3.Clark, D.A., et al., Time for an Australian and New Zealand randomized controlled trial to study the modified Kono S anastomosis. ANZ J Surg, 2022. 92(12): p. 3132-3134.