Conversion Rates and Outcomes of Laparoscopic Appendectomy in Complicated Appendicitis: A Retrospective Study

Background Laparoscopic appendectomy is a minimally invasive technique widely preferred for acute appendicitis due to less postoperative pain, faster recovery, and better cosmesis compared to open surgery. However, in complicated appendicitis, such as perforation, gangrene, abscess, or peritonitis-distorted anatomy, friable tissues, dense adhesions, and contamination can make the procedure technically demanding. These challenges may require conversion to open surgery, potentially increasing operative time, complications, and hospital stay. Objective To evaluate the conversion rate from laparoscopic to open appendectomy in patients with complicated appendicitis and to compare postoperative outcomes between converted and non-converted cases. Methodology This retrospective study included 393 patients who underwent laparoscopic appendectomy for complicated appendicitis at Shalamar Hospital, Lahore, Pakistan, from February 2022 to February 2025. Data were collected from patient records, operative notes, and discharge summaries. Variables included demographic details, intraoperative findings, reasons for conversion, operative time, postoperative complications, hospital stay, and 30-day readmissions. Statistical analysis was performed using SPSS version 25 (IBM Corp., Armonk, New York, USA), with a p-value < 0.05 considered significant. Results The conversion rate was 19.8% (n = 78). Common reasons for conversion included dense adhesions (41%), poor visualization (25.6%), and intraoperative bleeding (15.4%). Converted patients had significantly longer operative times (91.6 ± 22.4 vs. 61.7 ± 15.8 minutes, p < 0.001), higher surgical site infection rates (23.1% vs. 8.6%, p < 0.001), and longer hospital stays (5.6 ± 2.4 vs. 3.8 ± 1.6 days, p < 0.001). Risk factors associated with conversion included BMI > 30 (p = 0.004), CRP > 100 mg/L (p = 0.001), delayed presentation >48 hours (p = 0.001), and prior abdominal surgery (p = 0.03). Conclusion This study concludes that while laparoscopic appendectomy is effective for complicated appendicitis, conversion to open surgery is associated with increased morbidity. Early identification of high-risk patients based on clinical and laboratory parameters may help improve outcomes and surgical decision-making in complicated appendicitis.