Conversion-to-open in laparoscopic appendectomy: A cohort analysis of risk factors and outcomes

Finnerty, Brendan M.; Wu, Xian; Giambrone, Gregory P.; Gaber-Baylis, Licia K.; Zabih, Ramin; Bhat, Akshay U.; Zarnegar, Rasa; Pomp, Alfons; Fleischut, Peter; Afaneh, Cheguevara

doi:10.1016/j.ijsu.2017.03.016

Cited by 36 publications

(59 citation statements)

References 20 publications

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“…Similarly, we think that high rates of complicated appendicitis during the pandemic period also impacted the rates of conversion of laparoscopic surgery to open surgery during this period. While our rate of conversion to open surgery in non-pandemic periods was similar to the studies in the literature, this rate was higher during the pandemic period [6,7]. Moreover, we also found that the mean operation time during the pandemic period was longer as compared to the other periods.…”

Section: Discussionsupporting

confidence: 87%

Characteristics and Outcomes of Acute Appendicitis Cases During the COVID-19 Pandemic

Başer

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2020

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Background: Our aim in this study was to investigate the effects of the COVID-19 pandemic on acute appendicitis cases.Methods: This study was designed as a single-center, retrospective, and observational study. The patients were divided into three groups relative to the date of the first COVID-19 case in Turkey, which was March 10, 2020 (Group A: before the pandemic; Group B: pandemic period; Group C: the same period one year before the pandemic). A total of 413 patients were included in the study.Results: In terms of treatment modality, the rate of open appendectomy was significantly higher in group B (p<0.001). Rates of conversion to open surgery, as well as rates of complicated appendicitis were also significantly higher in group B (p=0.027, p=0.024, respectively). While there was no difference between the groups in terms of preoperative hospitalization duration (p=0.102), it was found that the duration of symptoms, operation time, and postoperative length of hospital stay were significantly higher in Group B (p<0.001, p=0.011, p=0.001, respectively). In addition, the complication rate in group B (8.9%) was also significantly higher than in the other two groups (p=0.023).Conclusion: We found that the rate of open surgery, the rate of conversion of laparoscopic surgery to open surgery, complication rates, mean operation time, and postoperative hospital stay were significantly higher in acute appendicitis patients that underwent surgery during the COVID-19 pandemic period. We believe that the main reason for this negative outcome is the late admission of the patients to the hospital.

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Section: Discussionsupporting

confidence: 87%

Characteristics and Outcomes of Acute Appendicitis Cases During the COVID-19 Pandemic

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2020

Preprint

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“…The ability to identify individual patient's risk factors of COS can aid surgeons in selecting those who may benefit from primary open surgery, thereby potentially reducing operative time, morbidity, and costs [25]. However, because our results suggested the feasibility of laparoscopic surgery for CVF, it is not necessary to delay the primary laparoscopic approach.…”

Section: Discussionmentioning

confidence: 77%

“…Recent studies on CVF by Badic et al [14] and Martinolich et al [22] reported COS incidence rates of 43% and 42%, respectively, comparable to our rate of 27%. During laparoscopic surgery in general, previously reported risk factors for COS included old age, male sex, high BMI, and previous abdominal operations [23][24][25]. Diverticular fistula cases, in particular, showed severe inflammation or dense fibrosis, impeding safe dissection, or ureteral visualization to be the most frequent reason for COS [22].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic surgery for diverticular colovesical fistula: single-center experience of 11 cases

et al. 2020

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Objective: Laparoscopic surgery for diverticular colovesical fistula (CVF) is technically challenging, and the incidence of conversion to open surgery (COS) is high. This study aimed to review our experience with laparoscopic surgery for diverticular CVF and identify preoperative risk factors for COS. Results: This was a single institution, retrospective, observational study of 11 patients (10 males and 1 female) who underwent laparoscopic sigmoid colon resection with fistula resection for diverticular CVF from 2014 to 2019. Preoperative magnetic resonance imaging (MRI) was performed to evaluate the fistula location in the bladder, patency of the rectovesical pouch (i.e., the destination of dissection procedure between sigmoid colon and bladder) and estimate the contact area between the sigmoid colon and bladder. The relationship between preoperative variables and COS incidence was analyzed between completed laparoscopy and COS groups. The overall incidence of postoperative morbidity (Clavien-Dindo classification Grade II or higher) was 36% (4/11). Severe morbidity, reoperation, and mortality were not observed. The incidence of COS was 27% (3/11). Posterior bladder fistulas were significantly associated with COS. CVFs located on the posterior bladder appears to be a risk factor for COS. Identifying risk factors for COS preoperatively could help guide the intraoperative course.

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“…Other risk factors for risk of conversion according to their study were male gender, black race, obesity and complications like abscess and peritonitis. 10 The mean duration of presentation was 2.72 days with maximum duration of 10 days. In all cases which underwent conversion to open surgery, the duration of history was above 4 days.…”

Section: Discussionmentioning

confidence: 97%

A study of pre-operative predictors for conversion to open surgery in emergency laparoscopic appendectomy

2020

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Background: Acute appendicitis is one of the most common emergencies encountered by surgeons. Although laparoscopic appendectomy is the preferred approach complicated appendicitis with a mass, abscess or perforation do present with a challenge to the operating surgeon compelling him to convert to open surgery. Our study aimed at identifying pre-operative factors that would help us predict the risk of conversion to open surgery.Methods: This was a prospective analytical study. All cases admitted over a period of one year undergoing emergency appendectomy were included in the study. The duration of history, clinical presentation, laboratory and radiological investigations were noted. The reason for conversion to open surgery was recorded. The post-operative stay and complications were analyzed.Results: A total of 160 patients fulfilling the inclusion criteria were included in the study. The mean age was 33.78 years with a male preponderance of 58%. The duration of history, clinical and radiological evidence of complicated appendicitis and peritonitis, total leucocyte count and serum bilirubin levels were identified as pre-operative predictors for risk of conversion to open surgery from laparoscopic appendectomy.Conclusions: These predictors are useful in predicting conversion to open surgery in laparoscopic emergency appendectomy. In these cases, proceeding with an open surgical approach may be beneficial to the patient in reducing operative time, cost, hospital stay and complications as laparoscopic approach may prove to be unsuccessful. This would help in enhanced communication between the surgeon and the patient with respect to the outcome and prognosis.

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Conversion-to-open in laparoscopic appendectomy: A cohort analysis of risk factors and outcomes

Abstract: CA patients have an unfavorable complication profile compared to OA. The predictors identified in this scoring model could help select for patients who may benefit from primary open appendectomy.

Cited by 36 publications

References 20 publications

Characteristics and Outcomes of Acute Appendicitis Cases During the COVID-19 Pandemic

Characteristics and Outcomes of Acute Appendicitis Cases During the COVID-19 Pandemic

Laparoscopic surgery for diverticular colovesical fistula: single-center experience of 11 cases

A study of pre-operative predictors for conversion to open surgery in emergency laparoscopic appendectomy

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