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

Authors Abe T, Nagaie T, Miyazaki M, Ochi M, Fukuya T, Kajiyama K

Received 13 December 2012

Accepted for publication 13 May 2013

Published 4 July 2013 Volume 2013:6 Pages 109—114


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Tomoyuki Abe,1 Takashi Nagaie,1 Mitsuhiro Miyazaki,1 Miho Ochi,2 Tatsuro Fukuya,2 Kiyoshi Kajiyama1

1Department of Surgery, Aso Iizuka Hospital, Iizuka City, Fukuoka, Japan; 2Department of Radiology, Aso Iizuka Hospital, Iizuka City, Fukuoka, Japan

Purpose: Laparoscopic 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.
Methods: Consecutive 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.
Results: Average 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.
Conclusion: Most 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.

Keywords: laparotomy, laparoscopic appendectomy, acute appendicitis

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