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Related Experiment Videos

CT predictors of failed laparoscopic appendectomy.

Bettina Siewert1, Vassilios Raptopoulos, Shiu-Inn Liu

  • 1Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA. bsiewert@caregroup.harvard.edu

Radiology
|November 5, 2003
PubMed
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High computed tomographic (CT) inflammation grades (4 or 5) predict conversion from laparoscopic to open appendectomy. These grades indicate advanced appendicitis with fluid or abscess, necessitating open surgery.

Area of Science:

  • Radiology
  • Surgical Oncology
  • Gastroenterology

Background:

  • Laparoscopic appendectomy is standard for appendicitis.
  • Predicting conversion to open surgery is clinically important.

Purpose of the Study:

  • To identify computed tomographic (CT) signs predicting laparoscopic appendectomy failure and conversion to open appendectomy.

Main Methods:

  • 234 patients undergoing attempted laparoscopic appendectomy with preoperative CT were analyzed.
  • CT findings (appendix location, appendicolith, cecal wall thickening, lymphadenopathy, diameter) and inflammation grade (0-5) were correlated with conversion.
  • Statistical analysis used Student t and chi2 tests.

Main Results:

  • No single CT finding reliably predicted conversion.

Related Experiment Videos

  • Appendiceal diameter showed a trend but no distinct cutoff.
  • High CT inflammation grades (4 or 5) were significantly associated with conversion (21% vs. 7% for grades 0-3, P <.04).

    • Conclusions:

    • Advanced CT inflammation grades (4 or 5) indicate periappendiceal fluid or abscess, predicting conversion to open appendectomy.
    • Laparoscopic appendectomy is generally successful, but high CT inflammation grades warrant consideration for primary open surgery.