Conversion to open surgery in minimally invasive surgery for ileocolonic Crohn’s disease: a national multicentre study

Abstract

Purpose Crohn’s disease (CD) patients may require recurrent surgeries due to the chronic and relapsing nature of the disease. Despite its technical challenges, minimally invasive surgery (MIS) offers potential benefits such as early recovery and reduced morbidity. This study aims to investigate the rate and risk factors of conversion from minimally invasive to open surgery for CD. Methods This retrospective, multicentre, observational study, promoted by the Italian Society of Colorectal Surgery (SICCR), enrolled all patients aged 16 or older undergoing elective, urgent, or emergent surgery for ileocolonic Crohn’s disease from June 1, 2018, to May 31, 2019. The primary endpoint was the conversion rate from minimally invasive to open surgery. Results In total, 816 patients were included. Patients who underwent conversion to open surgery had higher postoperative stoma rates (p = 0.001) and longer hospital stays (p = 0.017) compared to those completed with MIS. No significant differences were found between converted patients and those planned as open from the beginning. Regression analysis identified age, associated procedures and perforation as potential risk factors for conversion. Conclusion Regardless of the recognised advantages of MIS, approximately 10% of CD patients require conversion to open surgery. To optimise surgical outcomes, continuous efforts in patient selection, surgeon training, and technology advancement are essential in reducing conversions and improving the surgical management of Crohn’s disease.