Single‐Incision Laparoscopy‐First Strategy in Crohn's Disease: Risk Factors for Conversion and Surgical Outcomes

ABSTRACT Background Single‐incision laparoscopic surgery (SILS) is an evolving minimally invasive technique for Crohn's disease (CD). However, evidence regarding conversion risk, specifically in SILS, is limited. This study aimed to identify independent predictors of conversion to open surgery. Methods We retrospectively analyzed patients with CD who underwent intestinal resection using an SILS‐first strategy between April 2018 and October 2025. The patients were classified into conversion and non‐conversion groups. Logistic regression analyses were performed to analyze risk factors for conversion to open surgery. The model's performance was evaluated using receiver operating characteristic (ROC) analysis. Results Of 289 patients, 34 (11.8%) required conversion to open surgery. Additional ports were required in 30 (10.4%) patients; 22 of these were completed laparoscopically. Multivariate analysis identified fistula (odds ratio [OR]: 7.53, 95% confidence interval [CI]: 3.28–17.6), colon resection (OR: 4.26, 95% CI: 1.87–9.91), and smoking history (OR: 2.49, 95% CI: 1.09–5.77) as independent risk factors. The predictive model demonstrated good discrimination (area under the curve [AUC] = 0.81). Conversion was associated with a longer operative time and greater blood loss, whereas postoperative complications and length of hospital stay were similar between the groups. Conclusion The SILS‐first strategy achieved a low conversion rate, while maintaining operative safety. Risk factors for conversion were consistent with those reported in multi‐port laparoscopy, supporting a flexible and staged port‐escalation approach in CD.