Abstracts
2000 Digestive Disease Week

# 2324 Laparoscopic Surgery for Crohn’s Disease: Reasons for Conversion.
Max Schmidt, Mark A Talamini, Howard S. Kaufman, Robert C. Moesinger, Theodore M. Bayless, Baltimore, MD

Safety during laparoscopic surgery for Crohn’s disease depends upon prudence in deciding when to convert to an open procedure. This study of patients treated laparoscopically for complications of Crohn’s disease examines the circumstances and predictors of conversion to an open procedure. All patients with Crohn’s disease referred to two surgeons (MAT, HSK, January 1995-June 1999) were considered for laparoscopic management. The bowel was mobilized laparoscopically and extra corporeal anastomoses were performed. Conversion to open surgery was defined as creation of a >2 inch incision. Data were collected prospectively. Seventy-five patients (age 38.5±1.6 yrs) underwent 77 attempted laparoscopic procedures. There were 44 women and 31 men. Presenting symptoms were most commonly: pain(86%), nausea/anorexia(48%), diarrhea(41%) and weight loss(38%). Seventy three percent were taking steroids at the time of surgery. Indications for operation included: obstruction(58), fistula(24), failure of medical management(22), perineal sepsis(4), and gastrointestinal bleeding(1). Fifty-one of 77 (66%) operations were completed laparoscopically consisting of ileocecectomy(30), small bowel resection(15), fecal diversion(6), intestinal stricturoplasty(5), sigmoidectomy(1) and lysis of adhesions(1). In addition six procedures included takedown of an enteric fistula. Twentysix procedures(34%) were converted due to adhesions(23), enteric fistula(5), size of the lesion(2), or unclear anatomy(1). Forty percent of procedures in which the patients were taking steroids required conversion, compared with 26% when steroids were not being taken. Fifty percent of procedures preceded by weight loss required conversion, compared with 26% without weight loss (p=0.035). There were no intra-operative complications. The mean operative time for cases completed laparoscopically was 207 ±7 minutes. The mean blood loss was 133 ±21 cc. Postoperative complications included pelvic abscess(1) and stroke(1). Mean times to passage of flatus and first bowel movement were 3.5±0.2 days and 4.2±2.5 days, respectively. Mean time to discharge was 5.7±0.4 days. Conclusions: In this series, pre-operative weight loss correlated with conversion. Adequate nutrition may favor a successful laparoscopic outcome. Appropriate conversion led to an acceptable operative time, blood loss, and length of hospital stay. Safety during laparoscopic resection for Crohn’s disease depends upon a safe threshold for conversion to an open procedure.