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Predictive Factors for Conversion From Single Incision Appendectomy to Multiport Appendectomy for Pediatric Acute
Ko Miyazaki1, Makoto Hayashida1, Shoma Koga1
1Department of Pediatric Surgery, Fukuoka Children's Hospital, Fukuoka, Japan.
Asian Journal of Endoscopic Surgery
|July 28, 2026
Summary
Elevated C-reactive protein (CRP) levels and female sex are linked to difficulties in completing single-incision appendectomy (SIA). These findings suggest potential risk factors for conversion to multiport appendectomy (MPA) in pediatric patients.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Single-incision appendectomy (SIA) offers cosmetic benefits for acute appendicitis.
- Transumbilical laparoscopic-assisted appendectomy is the primary approach in this institution.
- Identifying factors predicting conversion to multiport appendectomy (MPA) is crucial for surgical planning.
Purpose of the Study:
- To identify risk factors associated with conversion from single-incision appendectomy (SIA) to multiport appendectomy (MPA) in pediatric patients.
- To analyze perioperative variables that may predict the need for conversion during appendectomy.
Main Methods:
- Retrospective cohort study of 129 pediatric patients (aged <15 years) undergoing appendectomy.
- Patients were divided into SIA completion group and MPA conversion group.
- Comparison of perioperative variables including C-reactive protein (CRP) levels, appendiceal diameter, symptom onset to visit time, and sex.
Main Results:
- Conversion to MPA was required in 38.8% of cases (50/129).
- Elevated preoperative CRP levels (OR 1.12) and female sex (OR 2.72) were independent risk factors for conversion.
- Significant intergroup differences were observed in CRP, appendiceal diameter, symptom onset duration, and sex.
Conclusions:
- Elevated preoperative CRP and female sex are significantly associated with conversion from SIA to MPA.
- These factors may indicate increased surgical difficulty or complexity in specific pediatric appendicitis cases.
- Larger prospective studies are recommended to confirm these findings and refine surgical strategies.
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