Predictors of conversion and outcomes after conversion in laparoscopic redo ileocolic resection for Crohn's disease.

Abstract

Redo ileocolic resection (ICR) for Crohn's disease is technically challenging, and surgeons often debate whether a laparoscopic approach should be attempted given the risk of conversion. We evaluated predictors of conversion and postoperative outcomes following conversion to inform operative decision-making. Patients undergoing redo ileocolic resection for Crohn's disease from 2009 to 2021 at a quaternary referral centre were identified from a prospectively maintained database. Cases were categorized as completed laparoscopically, converted or planned open. Predictors of conversion and perioperative outcomes were analysed. Among 436 redo ileocolic resections, 100 were attempted laparoscopically, with a 10% conversion rate. Penetrating disease was significantly associated with conversion. Postoperative outcomes after conversion were comparable to planned open surgery, including overall complications, readmission and reoperation. Length of stay was shorter after completed laparoscopy. Conversion during laparoscopic redo ileocolic resection is uncommon and primarily driven by penetrating disease. Importantly, outcomes after conversion approximate those of planned open surgery, supporting an initial laparoscopic approach in appropriately selected patients.