Single-Incision Laparoscopy-First Strategy in Crohn's Disease: Risk Factors for Conversion and Surgical Outcomes

Area of Science:

• Colorectal Surgery
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Single-incision laparoscopic surgery (SILS) is an emerging technique for Crohn's disease (CD) treatment.
• Limited data exists on conversion rates and predictors for SILS in CD.
• This study investigates factors influencing conversion from SILS to open surgery.

Purpose of the Study:

• To identify independent predictors of conversion to open surgery in patients with Crohn's disease undergoing SILS.
• To evaluate the safety and efficacy of a SILS-first approach for intestinal resection in CD.
• To assess the performance of a predictive model for conversion risk.

Main Methods:

• Retrospective analysis of 289 patients with CD undergoing SILS intestinal resection.
• Classification of patients into conversion and non-conversion groups.
• Logistic regression and ROC analysis to identify risk factors and model performance.

Main Results:

• 11.8% of patients required conversion to open surgery.
• Independent predictors for conversion included fistula (OR: 7.53), colon resection (OR: 4.26), and smoking history (OR: 2.49).
• The predictive model showed good discrimination (AUC = 0.81); conversion increased operative time and blood loss but not complications or hospital stay.

Conclusions:

• A SILS-first strategy for CD demonstrates a low conversion rate and maintains operative safety.
• Identified risk factors for conversion align with those in multi-port laparoscopy.
• Supports a flexible, staged port-escalation approach for SILS in CD patients.