Ghignone Federico, Taffurelli Giovanni, Greco Federica, Zattoni Davide, Montroni Isacco, Ugolini Giampaolo
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; General and Colorectal Surgery Unit, Ospedale Santa Maria delle Croci, Ravenna, Italy.
General and Colorectal Surgery Unit, Ospedale Santa Maria delle Croci, Ravenna, Italy. Electronic address: https://twitter.com/GioTaffu.
Surgery. 2025 Aug;184:109456. doi: 10.1016/j.surg.2025.109456. Epub 2025 Jun 2.
Patients who undergo ileo-colonic resection for Crohn disease are at risk of repeated surgery because of recurrence. Minimally invasive approach is debated in recurrent cases. This study aims to identify predictors for conversion to open surgery and explore if a repeated laparoscopic procedure represents a risk factor for conversion. Outcomes of recurrent versus primary surgery were also evaluated.
This is retrospective single-center cohort study enrolling all patients undergoing laparoscopic surgery for primary and recurrent ileo-colic Crohn disease between January 2017 and December 2023. Univariate and multivariate analysis according to the least absolute shrinkage and selection operator were carried out to identify factors associated with conversion to open surgery and postoperative outcomes.
A total of 202 patients were included; the mean age was 49 years. Half were malnourished and received steroids/biologics before surgery. One hundred twenty patients (59.4%) underwent surgery for stenosing disease. Most had American Society of Anesthesiologists score 1 or 2. One hundred thirty-four patients underwent primary ileo-colonic resection and 68 (33.6%) were operated for recurrence. Conversion rate was 10.3% (21/202). Mean length of stay was 5.2 days. Eight patients (3.9%) had severe complications, and anastomotic leak rate was 3.4%. Multivariate analysis showed that only American Society of Anesthesiologists score was a risk factor for conversion. No statistically significant differences were noted in terms of diverting stoma, complications, reoperation, length of stay, and readmission between primary and recurrent ileo-colonic resection.
Previous surgery for Crohn disease is not correlated with the risk of conversion; postoperative outcomes are not significantly different from those for primary ileo-colonic resection. Minimally invasive approach should be attempted in every patient undergoing surgery for recurrent Crohn disease.
因克罗恩病接受回结肠切除术的患者因疾病复发有再次手术的风险。复发病例中微创方法存在争议。本研究旨在确定转为开放手术的预测因素，并探讨再次腹腔镜手术是否是转为开放手术的危险因素。还评估了复发手术与初次手术的结果。
这是一项回顾性单中心队列研究，纳入了2017年1月至2023年12月期间因原发性和复发性回结肠克罗恩病接受腹腔镜手术的所有患者。根据最小绝对收缩和选择算子进行单变量和多变量分析，以确定与转为开放手术和术后结果相关的因素。
共纳入202例患者；平均年龄为49岁。一半患者营养不良，术前接受过类固醇/生物制剂治疗。120例患者（59.4%）因狭窄性疾病接受手术。大多数患者美国麻醉医师协会评分为1或2。134例患者接受了初次回结肠切除术，68例（33.6%）因复发接受手术。转换率为10.3%（21/202）。平均住院时间为5.2天。8例患者（3.9%）出现严重并发症，吻合口漏率为3.4%。多变量分析显示，只有美国麻醉医师协会评分是转为开放手术的危险因素。初次和复发性回结肠切除术在造口转流、并发症、再次手术、住院时间和再入院方面没有统计学上的显著差异。
既往克罗恩病手术与转为开放手术的风险无关；术后结果与初次回结肠切除术无显著差异。对于每一位接受复发性克罗恩病手术的患者，都应尝试采用微创方法。
