eP558 - Prior Pelvic Surgery in Females Does Not Influence the Risk of Conversion in Laparoscopic Ileocolic Crohn’s Resection

Purpose/Background: Laparoscopic surgery in Crohn’s disease (CD) has been shown to reduce hospital stay and complication rates. The success of laparoscopic CD surgery in females having prior pelvic surgery via a Pfannenstiel incision is not reported in the literature. We sought to characterize both the influence of prior pelvic surgery on conversion to open and the probability of successful reuse of a Pfannenstiel incision during laparoscopic ileocolic resection (ICR) in CD.Methods/Interventions: This is a retrospective analysis of female patients in a prospectively maintained IBD database from a single center between January 2007 and December 2021. We analyzed three groups of patients undergoing their first ICR with: 1) no previous surgery, 2) prior abdominal surgery or 3) a history of pelvic surgery performed through a Pfannenstiel incision. Pelvic surgery included hysterectomy, Cesarean section and any ovarian rectal, or open bladder surgery. Specimen extraction during laparoscopic ICR was accomplished at the discretion of the operating surgeon via either a right transverse incision, Pfannenstiel incision or midline incision. Categorical variables were compared with chi-square analysis and continuous variables compared with ANOVA.Results/Outcomes: The study cohort of 122 patients included 76 (62%) patients with no previous surgery, 23 (19%) patients with prior abdominal surgery and 23 (19%) patients with prior pelvic surgery (Table 1). The most performed operations in the prior abdominal surgery group were cholecystectomy (n=12; 52%) and appendectomy (n=6; 26%). The most performed operations in the pelvic surgery patient group were Cesarean section (n=14; 61%) and hysterectomy (n=7; 30%). The three patient groups were well matched except that patients with no prior surgery were significantly younger. Laparoscopy was completed in 109 (89%) patients. The laparoscopic completion rate did not differ significantly between patients without previous surgery (n=70; 92%), patients with prior abdominal surgery (n=18; 78%) and patients with prior pelvic surgery (n=21; 91%) (p=0.16). Specimen extraction was performed via a right transverse incision (n=65; 53%), Pfannenstiel incision (n=45; 37%) or midline incision (n=12; 10%). The use of a Pfannenstiel incision did not differ significantly between patients without previous surgery (n=31; 41%), patients with prior abdominal surgery (n=5; 22%) and patients with prior pelvic surgery (n=9; 39%) (p=0.13).Conclusion/

Discussion: Females with prior pelvic surgery undergoing their first ICR for CD demonstrate similar rates of laparoscopic completion and use of a Pfannenstiel incision compared to females with no prior operations and females with prior abdominal surgery. Prior pelvic surgery should not be viewed as a contraindication to laparoscopic approach in CD patients requiring ICR.Table 1: Demographics & Operative InformationAnalysis is presented among the 3 groups: No prior operations, prior abdominal surgery, and prior pelvic surgery.