Abstract
BackgroundIn this study, we identified preoperative risk factors, including imaging features and blood tests, to predict conversion from laparoscopic appendectomy to open appendectomy. Thus, we aimed to prevent patients from being exposed to the risks of laparoscopy by choosing patients for whom proceeding directly to an open surgery as an initial approach was appropriate.Patients and methodsThe cohort of 632 patients who underwent laparoscopic appendectomy due to acute appendicitis in our center between January 2017 and March 2021 were analyzed, and 521 of these patients comprised the study population. Baseline characteristics, medical history, preoperative laboratory tests, imaging features, and postoperative pathologic findings of all patients according to groups who underwent laparoscopic appendectomy or conversion to open appendectomy were examined.ResultsAmong 521 patients, the appendectomy procedure was completed laparoscopically in 498 (95.6%) patients, and conversion to open appendectomy was occurred in 23 (4.4%) patients. 223 (42.8%) patients were female, and 298 (57.2%) patients were male. The mean age of all patients was 35.17±12.61 years (range, 16-80 years). Preoperative ultrasonography feature associated with a higher rate of conversion was free fluid collection (p=0.001). The levels of C-reactive protein, neutrophil, and neutrophil/lymphocyte ratio on admission were found to be significantly higher in the conversion group compared to the laparoscopy group (p=0.001, p=0.027, p=0.02, respectively). ConclusionsFree fluid collection detected by ultrasonography, and elevation of C-reactive protein, neutrophil, and neutrophil/lymphocyte ratio may be useful in the prediction of a high risk of conversion appendectomy. Despite the unquestionable advantages of laparoscopic surgery, there are still substantial conversion rates. Within this framework, our study will help the surgeons to choose the most appropriate surgical methods for patients by evaluating them individually, and to inform them of the possibility of conversion to the open approach, and other risks before surgery.
Highlights
The lifetime risk of acute appendicitis in an adult population ranges from 7% to 8%, and 10% of the patients having symptoms of acute appendicitis usually resulting in the removal of a normal appendix [1, 2]
Preoperative ultrasonography feature associated with a higher rate of conversion was free fluid collection (p=0.001)
The levels of C-reactive protein, neutrophil, and neutrophil/lymphocyte ratio on admission were found to be significantly higher in the conversion group compared to the laparoscopy group (p=0.001, p=0.027, p=0.02, respectively)
Summary
The lifetime risk of acute appendicitis in an adult population ranges from 7% to 8%, and 10% of the patients having symptoms of acute appendicitis usually resulting in the removal of a normal appendix [1, 2]. The conversion from laparoscopy to open surgery means perioperative adverse outcomes such as increased blood loss, additional incision, lengthened operative time, and postoperative adverse outcomes such as more analgesic requirement, delayed oral intake, wound infection, How to cite this article Yigit B, Cerekci E, Cakir Y, et al (August 11, 2021) Efficacy of Preoperative Imaging Features and Blood Tests in Predicting the Increased Risk of Conversion in Laparoscopic Appendectomy Surgery. Several studies were conducted to explain the predictor factors for conversion appendectomy (CA), including dense adhesions, diffuse peritonitis, and difficulties in excision of the appendix due to perforation or severe inflammation, but no algorithm has been developed so far [5,6,7]. We identified preoperative risk factors, including imaging features and blood tests, to predict conversion from laparoscopic appendectomy to open appendectomy. We aimed to prevent patients from being exposed to the risks of laparoscopy by choosing patients for whom proceeding directly to an open surgery as an initial approach was appropriate
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