Publication:

Predictors for conversion to open appendicectomy in patients undergoing laparoscopic appendicectomy: a prospective study

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.