Skip to main content
2024 ASCRS Annual Scientific Meeting Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
CME
CME
Invitation/Ticketed Event
Invitation/Ticketed Event
Invited Lectureship
Invited Lectureship
Award Recipient
Award Recipient
Live Streamed Session
Live Streamed Session
Nurses Contact Hours
Nurses Contact Hours
Self-Assessment
Self-Assessment
Back

Session: ePoster Monitor 1-Benign Abdominal Disease and IBD

eP263 - Laparoscopic Redo Ileocolic Resection for Crohn's Disease: Why Do We Convert, and How Do Patients Do?

Sunday, June 2, 2024
12:03 PM – 12:08 PM ET, USA
Location: Baltimore Convention Center, Room 318-320

    ePoster Presenter(s)

  • GA

    Gilad Alon, MD (he/him/his)

    colorectal Surgery Fellow
    Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio
    The Cleveland Clinic
    Beachwood, OH, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • MB

    Mikhael Belkovsky, MD

    Colorectal Surgery Research Fellow
    Department of Colorectal Surgery, Cleveland Clinic
    Cleveland, Ohio, United States

    Disclosure information not submitted.

  • TU

    Tairin Uchino, MD

    colorectal Surgery Fellow
    Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH
    cleveland, Ohio, United States

    Disclosure information not submitted.

  • SJ

    Sami Judeeba, MD

    Staff Surgeon
    Cleveland Clinic
    Cleveland, Ohio, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Stefan D. Holubar, MD, MS

    Director of Research, Staff Surgeon
    Department of Colorectal Surgery, Cleveland Clinic
    Cleveland, Ohio, United States

    Disclosure information not submitted.

Purpose/Background: Over 80% of patients with primary ileocolic Crohn’s disease require surgical resection within a decade of diagnosis, with 40%-50% requiring further surgery within 15 years. Laparoscopic surgery for redo ileocolic resection may be challenging due to altered anatomy with scars, adhesions, inflamed tissues, and penetrating complications, such as abdominal abscesses and fistulae. In this study, we aimed to analyze the success rate, safety, and short-term outcomes of the laparoscopic approach.Methods/Interventions: Patients who underwent redo ileocolic resection for Crohn's disease, between 2009-2021 at our institution were identified using a prospectively maintained database. Patients were stratified into three groups: laparoscopic, laparoscopic-converted, and open surgery. Using univariate analysis, we analyzed the conversion rates to open technique, patient characteristics, and perioperative outcomes.Results/Outcomes:: A total of 436 redo ileocolic resections were performed: 336 (77%) were performed using an open surgery technique. Laparoscopic techniqe was performed in 100 (20.1%) cases, of which 91 (91%) were completed laparoscopically, and 9 (9%) patients were converted to open surgery. The reasons for conversion were adhesions (n=7, 78%), difficult specimen extraction (n=1, 11%), and inability to locate the ureter (n=1, 11%). The groups did not differ in terms of age, BMI, steroid use, or use of biological agents. Converted cases, compared to laparoscopic and open cases, tended to be male (60% vs. 40% vs. 53.6%, p=0.06) and had more penetrating diseases (40% vs. 14.4% vs. 32.1%, p=0.001). Perioperative outcomes did not differ in terms of overall complications, readmission, reoperation, surgical wound infections, and anastomosis leak. Laparoscopic approach had a shorter median length of stay, while converted and open were not different (5 vs. 7 vs. 7 days, p=0.04).Conclusion/

Discussion: Laparoscopic redo ileocolic resection for Crohn's is safe and can be successfully completed with a low conversion rate. Conversion was more common in patients with penetrating complications. In cases where an attempted laparoscopic approach is converted to open surgery, short-term outcomes are similar to the primary chosen open technique. A laparoscopic approach can provide short-term benefits."Table 1. Baseline characteristics laparoscopic vs converted vs open redo ileocolic resection for Crohn’s disease, Nf436

Figures represent frequencies (proportions) or medians (interquartile ranges).
Table 2. Complications laparoscopic vs converted vs open redo ileocolic resection for Crohn’s disease, Nf436

Figures represent frequencies (proportions) or medians (interquartile ranges)."