<b>Conversión en colectomías laparoscópicas: preventiva o reactiva. ¿Hay diferencias? </b>

ABSTRACT Background. Conversion to open surgery during laparoscopic colectomy may be necessary under certain intraoperative circumstances. This conversion can be preventive, when performed in anticipation of technical or anatomical challenges, or reactive, when it occurs in response to intraoperative complications. Understanding whether the type of conversion affects postoperative outcomes is essential for optimizing surgical decisions and improving patient safety. Objective. To compare postoperative outcomes between patients who undergo preventive and reactive conversion during laparoscopic colectomies. Design: An observational, comparative, retrospective study based on a prospectively maintained database. Method: All patients who were converted to open surgery during laparoscopic colectomy between January 2019 and May 2025 were included. The cohort was divided into two groups: preventive conversion (CP) and reactive conversion (CR). Demographic, intraoperative, and postoperative variables were analyzed. Results: During the study period, 63 laparoscopic colectomies required conversion: 46 (73%) were CP and 17 (27%) were CR. No significant demographic differences were observed across groups. Major morbidity (Clavien-Dindo III/IV) (CP: 4 (8.7) vs. CR: 9 (52.9); p=0.001), reoperations (CP: 5 (10.8) vs. CR: 7 (41.1); p=0.01), ICU stays (CP: 1.9 days vs. CR: 8.4 days; p=0.001), and mortality rates (CP: 1 (2.2) vs. CR: 4 (23.5); p=0.01) were significantly higher in CR. Conclusion: Reactive conversion during laparoscopic colectomies is associated with higher rates of major morbidity, reoperations, prolonged ICU stays, and mortality compared to preventive conversion.