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Repeated surgery for recurrence is not a risk factor for conversion in patients undergoing laparoscopic ileo-colonic
Federico Ghignone1, Giovanni Taffurelli2, Federica Greco3
1Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; General and Colorectal Surgery Unit, Ospedale Santa Maria delle Croci, Ravenna, Italy.
Background:
Patients who undergo ileo-colonic resection for Crohn disease are at risk of repeated surgery because of recurrence. Minimally invasive approach is debated in recurrent cases. This study aims to identify predictors for conversion to open surgery and explore if a repeated laparoscopic procedure represents a risk factor for conversion. Outcomes of recurrent versus primary surgery were also evaluated.
Methods:
This is retrospective single-center cohort study enrolling all patients undergoing laparoscopic surgery for primary and recurrent ileo-colic Crohn disease between January 2017 and December 2023. Univariate and multivariate analysis according to the least absolute shrinkage and selection operator were carried out to identify factors associated with conversion to open surgery and postoperative outcomes.
Results:
A total of 202 patients were included; the mean age was 49 years. Half were malnourished and received steroids/biologics before surgery. One hundred twenty patients (59.4%) underwent surgery for stenosing disease. Most had American Society of Anesthesiologists score 1 or 2. One hundred thirty-four patients underwent primary ileo-colonic resection and 68 (33.6%) were operated for recurrence. Conversion rate was 10.3% (21/202). Mean length of stay was 5.2 days. Eight patients (3.9%) had severe complications, and anastomotic leak rate was 3.4%. Multivariate analysis showed that only American Society of Anesthesiologists score was a risk factor for conversion. No statistically significant differences were noted in terms of diverting stoma, complications, reoperation, length of stay, and readmission between primary and recurrent ileo-colonic resection.
Conclusions:
Previous surgery for Crohn disease is not correlated with the risk of conversion; postoperative outcomes are not significantly different from those for primary ileo-colonic resection. Minimally invasive approach should be attempted in every patient undergoing surgery for recurrent Crohn disease.
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