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Conversion to open following a minimally invasive surgical attempt in inflammatory bowel disease is not associated
Shannon N Radomski1, Michael Consul2, Miloslawa Stem2
1Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Halsted 658, 600 N Wolfe Street, Baltimore, MD, 21287, USA. sradoms1@jhmi.edu.
Background:
Use of minimally invasive surgical (MIS) techniques in the management of patients with inflammatory bowel disease (IBD) is increasing. The aim of this study was to compare postoperative morbidity in patients who underwent planned open procedures to those who had an unplanned conversion to open.
Methods:
This study was a retrospective analysis of the ACS-NSQIP colectomy and proctectomy targeted databases from 2016 to 2022 in adult patients with a diagnosis of either Crohn's disease (CD) or ulcerative colitis (UC). Patients were stratified by surgical approach, and propensity score matching was used to compare the primary outcome of 30-day overall morbidity between planned open procedures and MIS procedures converted to open.
Results:
A total of 23,272 patients met the inclusion criteria. Of the 2343 robotic procedures, 181 (7.7%) were converted to an open approach. For laparoscopic CD and UC cases, 1266 (13.8%) and 334 (6.5%), respectively, were converted to open. Patients who underwent an attempted robotic approach for UC that was converted to open (n = 59) had similar rates of overall and serious morbidity compared to planned open cases (33.9% vs. 30.5%, p = 0.694, and 27.1% vs. 13.6%, p = 0.067, respectively). For laparoscopic UC cases, there were similar rates of overall and serious morbidity compared to planned open UC cases (38.8% vs. 32.1%, p = 0.073, and 20.0% vs. 17.6%, p = 0.425, respectively). Attempted robotic approaches for CD that were converted to open (n = 119) had similar rates of overall and serious morbidity compared to planned open cases (35.3% vs. 26.1%, p = 0.122, and 21.9% vs. 19%, p = 0.247, respectively). For laparoscopic CD cases, there were similar rates of overall and serious morbidity compared to planned open CD cases (27.4% vs. 29.7%, p = 0.200, and 15.8% vs. 16.8%, p = 0.517, respectively).
Conclusions:
Conversion to open following an initial MIS approach in patients with IBD is not associated with worse outcomes compared to planned open procedures.
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