Predictors of conversion in laparoscopic Crohn’s surgery: a retrospective analysis of a tertiary cohort

Background Laparoscopy is the preferred approach for ileocecal resection in Crohn’s disease, yet conversion to open surgery remains clinically significant. This study aimed to identify independent preoperative predictors of conversion using penalized regression (LASSO) and evaluate its impact on postoperative safety. Methods A retrospective cohort study included adult patients undergoing elective laparoscopic ileocecal resection at a tertiary center between 2011 and 2025. Multivariable logistic regression with least absolute shrinkage and selection operator (LASSO) regularization was performed to identify robust predictors of conversion while minimizing overfitting. Postoperative outcomes were compared between laparoscopic and converted groups. Results Of 575 patients, 90 (15.7%) required conversion. LASSO analysis identified older age (OR 1.02; 95% CI 1.00–1.04; p = 0.024) and fistulizing behavior (OR 1.98; 95% CI 1.08–3.62; p = 0.026) as independent risk factors. Conversely, a stenotic phenotype was protective (OR 0.53; 95% CI 0.29–0.96; p = 0.036). While conversion was associated with longer hospital stays ( p = 0.009) and increased medical complications (25.6% vs. 14.4%; p = 0.013), it did not increase the rate of major surgical complications (7.8% vs. 6.4%; p = 0.799) or reoperations ( p = 1.000). Conclusion Conversion was independently predicted by older age and fistulizing disease, whereas stenotic behavior was protective. Although associated with higher medical morbidity, conversion did not compromise surgical safety, supporting its role as a proactive maneuver for complex disease rather than a technical failure.