Risk factors for additional port insertion in single-port laparoscopic appendectomy

Area of Science:

• Minimally Invasive Surgery
• Surgical Outcomes
• Appendicitis Management

Background:

• Single-port laparoscopic appendectomy (SPLA) offers potential benefits like reduced infection and improved cosmesis over conventional laparoscopic appendectomy (CLA).
• Conversion from SPLA to CLA negates many of these anticipated surgical advantages.
• Identifying predictors of conversion is crucial for optimizing patient selection and surgical planning for SPLA.

Purpose of the Study:

• To identify risk factors associated with conversion from single-port laparoscopic appendectomy (SPLA) to conventional laparoscopic appendectomy (CLA).

Main Methods:

• Retrospective review of 409 patients undergoing intended SPLA between August 2015 and December 2016.
• Conversion defined as additional port insertion; complicated appendicitis defined by CT findings (gangrenous, perforated, abscess, peritonitis).
• Statistical analysis (univariable and multivariable) to determine significant risk factors for conversion.

Main Results:

• A total of 65 patients (15.9%) required conversion from SPLA to CLA.
• Significant risk factors for conversion included older age, male sex, elevated serum C-reactive protein (OR=2.944), and complicated appendicitis (OR=3.330).
• Overall complication rates were similar (1.5%) between groups, with surgical site infections noted in the SPLA group.

Conclusions:

• The conversion rate from SPLA to CLA in this cohort was 15.9%.
• Elevated serum C-reactive protein levels and the presence of complicated appendicitis are strong predictors for conversion.
• These factors can aid in pre-operative risk assessment for patients undergoing intended SPLA.