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Factors associated with conversion to laparotomy in patients undergoing laparoscopic appendectomy
Shiuh-Inn Liu1, Bettina Siewert, Vassilios Raptopoulos
1Department of Surgery, Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
Journal of the American College of Surgeons
|March 15, 2002
Summary
Preoperative factors like older age, diffuse tenderness, and less surgeon experience predict conversion from laparoscopic to open appendectomy. Advanced CT findings also increase conversion risk, aiding surgical decision-making.
Area of Science:
- Surgical Innovation
- Gastrointestinal Surgery
- Clinical Predictors
Background:
- Laparoscopic appendectomy (LA) offers advantages but may require conversion to open appendectomy (OA) due to complications or inflammation.
- Identifying preoperative predictors for conversion is crucial for surgical planning.
Purpose of the Study:
- To identify preoperative factors associated with conversion from LA to OA.
- To improve decision-making in appendicitis management.
Main Methods:
- Retrospective review of 705 patients undergoing surgery for suspected appendicitis.
- Analysis of factors including patient demographics, symptoms, physical findings, and surgeon experience.
- Multivariate analysis incorporating preoperative CT scan findings in 261 patients.
Main Results:
- Conversion to OA occurred in 9.7% of cases, primarily due to adhesions, perforation, or peritonitis.
- Significant predictors for conversion included age ≥ 65, diffuse tenderness, and surgeon experience ≤ 10 LA procedures.
- Preoperative CT findings of fat stranding, inflammatory mass, or abscess significantly increased conversion likelihood.
Conclusions:
- Preoperative identification of conversion predictors can guide surgical strategy for appendicitis.
- Judicious use of LA can be enhanced by understanding factors necessitating conversion to OA.