title: Factors that predict conversion in 69 consecutive patients undergoing laparoscopic ileocecal resection for Crohn's disease: a prospective study.
abstract: OBJECTIVE
  This prospective study was designed to identify factors that could predict conversion in patients undergoing first laparoscopic ileocecal resection for Crohn's disease.
  
  
  METHODS
  Between 1998 and 2004, 69 consecutive patients (32 males; mean age, 32 +/- 9 years) who had undergone a first laparoscopic ileocecal resection for Crohn's disease were included in a prospective study. Twenty-one patients (30 percent) were converted into laparotomy. Possible factors for conversion were analyzed by both univariate and multivariate analyses.
  
  
  RESULTS
  No patient died. Four patients (9 percent; 2 in each group) required five reoperations because of intraperitoneal hemorrhage (n = 1), anastomotic fistula (n = 3), and small-bowel obstruction (n = 1). Mean hospital stay was significantly increased in converted compared with laparoscopic patients (9 +/- 4 vs. 7 +/- 3 days; P < 0.05). On univariate analysis, more than three episodes of acute flare of Crohn's disease (P = 0.02), male gender (P = 0.03), preoperative immunosuppressive drugs (P = 0.04), intra-abdominal abscess or fistula at the time of laparoscopy (P = 0.02), and resection of other intestinal segment (P = 0.02) were factors that predicted conversion. On multivariate analysis, recurrent medical episodes of Crohn's disease (odds ratio, 2; 95 percent confidence interval, 1-4), and intra-abdominal abscess or fistula at the time of laparoscopy (odds ratio, 15; 95 percent confidence interval, 4-78) were the two independent risk factors for conversion.
  
  
  CONCLUSIONS
  This prospective study demonstrated that the severity of the disease increased significantly the conversion rate of the first laparoscopic ileocecal resection. Knowledge of these risk factors for conversion could be helpful in preoperative preparation and counseling of patients.
authors.affiliation: Department of Surgery, Lariboisiere Hospital, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Alves
authors.forename: Y
authors.initials: Y
authors.lastname: Panis
authors.forename: Y
authors.initials: Y
authors.lastname: Bouhnik
authors.forename: C
authors.initials: C
authors.lastname: Marceau
authors.forename: Y
authors.initials: Y
authors.lastname: Rouach
authors.forename: A
authors.initials: A
authors.lastname: Lavergne-Slove
authors.forename: E
authors.initials: E
authors.lastname: Vicaut
authors.forename: P
authors.initials: P
authors.lastname: Valleur
mesh_terms: D000038:Abscess / Q000150:complications; D000328:Adult; D002432:Cecum / Q000601:surgery; D003376:Counseling; D003424:Crohn Disease / Q000601:surgery*; D005260:Female; D005402:Fistula / Q000150:complications; D006801:Humans; D007082:Ileum / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index