Predictors for conversion to open appendicectomy in patients undergoing laparoscopic appendicectomy: a prospective study
DOI:
https://doi.org/10.18203/2349-2902.isj20182779Keywords:
Conversion appendicectomy, Conversion predicting score, Laparoscopic appendicectomy, Predictors of conversionAbstract
Background: Laparoscopic appendicectomy is a common surgery performed by emergency surgeons now-a-days. The conversion from laparoscopic to open appendicectomy increases operating time and post-operative morbidity. Identifying the variables associated with the risk of conversion pre-operatively would avoid wasteful laparoscopic attempts by proceeding directly to an open surgery. Therefore, developing a pre-operative criterion to decide ideal operative approach for individuals may be useful.
Methods: Patients admitted to the Department of General Surgery with appendicitis, who got converted to open appendicectomy were studied prospectively based on the reasons for their conversion and were compared with primary open appendicectomy patients with respect to postoperative morbidity and mortality. There were 385 cases among which there were 307 (79.74%) laparoscopic appendicectomies, 42 (10.9%) primary open appendicectomies and 36 (9.35%) conversion appendicectomies.
Results: Fourteen significant predictors of conversion were identified by univariate analysis. Ten independent risk factors were identified by stepwise logistic regression.
Conclusions: The commonest reason for conversion was appendix mass. Post-operative pain, complications and duration of hospital stay were higher in conversion appendicectomy when compared to open appendicectomy. A conversion predicting score of >4 had good sensitivity and negative predictive value.
References
Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132:910-25.
McBurney C. IV. The incision made in the abdominal wall in cases of appendicitis, with a description of a new method of operating. Ann Surg. 1894;20:38-43.
Berry J Jr, Malt RA. Appendicitis near its centenary. Ann Surg. 1894;200(5):567-75.
Bryan R. The Appendix. In: Townsend, Beauchamp, Evers, Mattox, eds. Sabiston text book of Surgery. 20th ed. Philadelphia: Elsevier Inc;2017:1279.
Garg CP, Vaidya BB, Chengalath MM. Efficacy of laparoscopy in complicated appendicitis. Int J Surg. 2009;7(3):250-2.
Golub R, Siddiqui F, Pohl D. Laparoscopic versus open appendectomy: a metaanalysis. J Am Coll Surg. 1998;186:545-53.
Garbutt JM, Soper NJ, Shannon WD, Botero A, Littenberg B. Meta-analysis of randomized controlled trials comparing laparoscopic and open appendectomy. Surg Laparosc Endosc. 1999; 9:17-26.
Chung RS, Rowland DY, Li P, Diaz J. A meta-analysis of randomized controlled trials of laparoscopic versus conventional appendectomy. Am J Surg. 1999;177:250-6.
Tarnoff M, Atabek U, Goodman M, Alexander JB, Chrzanowski F, Mortman K et al. A comparison of laparoscopic and open appendectomy. J Soc Laparoendosc Surg. 1998;2:153-8.
Tomoyuki A, Takashi N, Mitsuhiro M, Miho O, Tatsuro F, Kiyoshi K. Risk factors of converting to laparotomy in laparoscopic appendectomy for acute appendicitis. Clinical Exptal Gastroenterol. 2013;6:109.
Garbutt JM, Soper NJ, Shannon WD, Botero A, Littenberg B appendectomy. Surg Laparosc Endosc. 1999;9:17-26.
Martin LC, Puente I, Sosa JL, Bassin A, Breslaw R, McKenney MG et al. Open versus laparoscopic appendectomy. A prospective randomized comparison. Ann Surg. 1995;222(3):256-61.
Liu SI, Siewert B, Raptopoulos V, Hodin RA. Factors associated with conversion to laparotomy in patients undergoing laparoscopic appendectomy. J Am Coll Surg. 2002;194(3):298-305.
Varela JE, Hinojosa MW, Nguyen NT. Laparoscopy should be the approach of choice for acute appendicitis in morbidly obese. Am J Surg. 2008;196:218-22.
Natasha G, David MA, Keturah B, Vijay KM. Identification of preoperative risk factors associated with the conversion of laparoscopic to open appendectomies. Int Surg. 2013;98:334-9.
Namir K, Rodney JM, Shirin T, Anna G, Rahila E. Laparoscopic versus open appendectomy a prospective randomized double-blind study. Ann Surg. 2005;242:439-50.
