Laparoscopic surgery for Crohn's disease: Reasonsfor conversion

Results One hundred ten patients (age 37 6 1.1 years, 58% female) underwent 113 attempted laparoscopic interventions. Indications for surgery included obstruction (77%), failure of medical management (35%), fistula (27%), and perineal sepsis (4%). Sixty-eight procedures (60%) were completed laparoscopically. Procedures completed laparoscopically included ileocecectomy (n 5 46), small bowel resection (n 5 22), fecal diversion (n 5 7), intestinal stricturoplasty (n 5 7), resection of prior ileocolonic anastomosis (n 5 5), segmental colectomy (n 5 1), and lysis of adhesions (n 5 1). Forty-five procedures (40%) were converted as a result of adhesions (n 5 21), extent of inflammation or disease (n 5 9), size of the inflammatory mass (n 5 7), inability to dissect a fistula (n 5 5), or inability to assess anatomy (n 5 3). Factors associated with conversion were internal fistula as an indication for surgery, smoking, steroid administration, extracecal colonic disease, and preoperative malnutrition. In laparoscopic patients, mean times to passage of flatus and first bowel movement were 3.6 6 0.2 days and 4.4 6 0.2 days, respectively. Mean time to discharge was 6 6 0.2 days.