Risk factors of converting to laparotomy in laparoscopic appendectomy for acute appendicitis

Abstract

PurposeLaparoscopic appendectomy (LA) for acute appendicitis has several advantages over open appendectomy (OA). In cases of complicated appendicitis, LA is converted to OA at a constant rate, though converting appendectomy (CA) has several disadvantages. We retrospectively determined preoperative risk factors for failure of LA and subsequent conversion to OA.MethodsConsecutive cases of preoperative computed tomography (CT) and attempted LA were retrieved from our hospital database and grouped by procedure (LA versus CA). Patients with negative appendectomies (n = 28), opened appendectomy (n = 210), delayed interval appendectomy (n = 3), or who were <14 years of age were excluded.ResultsAverage patient age, preoperative C-reactive protein (CRP) level, and diffuse peritonitis were significantly different between the groups. CT inflammation and occurrence of complicated appendicitis were significantly higher in CA than LA. Conversion to OA was mostly because of dense adhesions, diffuse peritonitis, and difficulties in excision of the appendix due to perforation or severe inflammation from surgical point of view. Postoperative complications were significantly lower in LA than CA, although the rate of intraoperative abscess was not different.ConclusionMost patients with acute appendicitis can be successfully treated with LA. We identified the following significant risk factors of CA: CT inflammation grade 4 or 5; complicated appendicitis; higher preoperative CRP level; and diffuse peritonitis.

Neutrophil - Lymphocyte Ratio and Mean Platelet Volume Can Be a Predictor for the Severity of Acute Appendicitis

“…Abe et al recently reported that complicated appendicitis and diffuse peritonitis were risk factors of conversion to open during laparoscopic appendectomy. [28] Furthermore, in a comparison of open to laparoscopic appendectomies, the Cochrane review reported a nearly threefold increase in intra-abdominal abscesses following laparoscopic appendectomy, which may lead surgeons to choose open appendectomy in cases of perforated appendicitis. [29] …”

Preoperative C-reactive protein predicts the severity and likelihood of complications following appendicectomy

“…Only two studies identify CRP as a marker for complications with appendicectomy. 24,25 CRP is one of the body's acute phase inflammatory markers. 26 A higher level of CRP is therefore suggestive of a more intense local inflammatory reaction and more severe appendicitis.…”

“…A study from 2013 corroborates our outcomes, showing that with a higher CRP, there is an increased conversion rate from LA to LCOA. 25 The paper stated that a preoperative CRP of >100mg/l is a statistically significant predictor of LCOA. In order to build on this concept, our study shows that not only does a high CRP make the procedure more challenging technically (resulting in a higher conversion rate) but it also increases the chance of complications arising in the LA group.…”

Appendicitis Computed Tomography Score: a Useful Tool for Predicting Perforation and Surgical Course of Acute Appendicitis

“…Conversion from a laparoscopic to an open procedure results in a larger abdominal wound, increased operating time, longer hospital stay, and a higher overall complication rate. 10,12 This results in higher hospital operational costs. Together with the additional resources required for the use and cleaning of laparoscopic equipment, the ability to prognosticate the odds of requiring open surgery and the duration of operating time may help the surgeon to decide the appropriate initial surgical approach and the time for conversion to open surgery.…”