The role of preoperative C-reactive protein value and neutrophil ratio in determination of conversion from laparoscopic appendectomy to open appendectomy

Aydın, Hüseyin; Avci, Tevfik; Tezcaner, Tugan; Kırnap, Mahir; Yıldırım, Sedat; Moray, Gökhan

doi:10.5505/tjtes.2018.68705

Cited by 5 publications

(12 citation statements)

References 15 publications

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“…In our present retrospective analysis of 1220 patients undergoing laparoscopic appendectomy, a conversion to open procedure was necessary in 67 cases (5.4%), which is consistent with previously published conversion rates [8,[11][12][13][14]16,17,20].…”

Section: Discussionsupporting

confidence: 91%

“…These intraoperative parameters have also already been reported in the literature [14,17]. The association of a higher preoperative WBC count with an increased conversion rate, which was detected in our study, has not been described in previous studies [12,15,16,21]. Similarly to an increased CRP, an increased WBC count may also represent the expression of a more advanced appendicitis, which makes this association appear plausible.…”

Section: Discussionsupporting

confidence: 85%

“…The identification of five of the six aforementioned risk factors is supported by previous studies [8,14,16,17,21]. Aydin et al and Yigit et al already demonstrated a significantly higher preoperative CRP level in patients who required conversion compared to those undergoing laparoscopic appendectomy, although the optimal cut off for a high CRP level varies slightly between the studies (≥108.5 mg/dL [12] and ≥119 mg/dL [15] vs. ≥95 mg/dL in our study). The level of the preoperative CRP may express the extent of appendicitis, which may be decisive for the decision to convert.…”

Section: Discussionsupporting

confidence: 84%

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Risk Factors for Conversion from Laparoscopic to Open Appendectomy

Laverde

Maak

Langheinrich

et al. 2023

JCM

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(1) Background: Since its introduction in the 1990s, laparoscopic appendectomy has become established over the years and is today considered the standard therapy for acute appendicitis. In some cases, however, a conversion to the open approach is still necessary. The primary aim of this study was to identify risk factors for the need to convert from the laparoscopic to an open approach during appendectomy for acute appendicitis. (2) Methods: A retrospective analysis of 1220 adult patients who underwent laparoscopic appendectomy for acute appendicitis from 2010 to 2020 at the University Hospital Erlangen was performed. Data, including patient demographics and pre-, intra-, and postoperative findings, were collected and compared between patients with and without conversion. (3) Results: The conversion rate in our cohort was 5.5%. A higher preoperative WBC count and CRP (OR 1.9, p = 0.042, and OR 2.3, p = 0.019, respectively), as well as the presence of intraoperative perforation, necrosis or gangrene, perityphlitic abscess and peritonitis (OR 3.2, p = 0.001; OR 2.3, p = 0.023; OR 2.6, p = 0.006 and OR 2.0, p = 0.025, respectively) were identified as independent risk factors for conversion from the laparoscopic to the open approach. Conversion was again independently associated with higher morbidity (OR 2.2, p = 0.043). (4) Conclusion: The laparoscopic approach is feasible and safe in the majority of patients with acute appendicitis. Only increased inflammatory blood markers could be detected as the preoperative risk factors potentially influencing the choice of surgical approach but only with low specificity and sensitivity. For the decision to convert, intraoperative findings are additionally crucial. However, patients with conversion should receive special attention in the postoperative course, as these have an increased risk of developing complications.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 84%

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Risk Factors for Conversion from Laparoscopic to Open Appendectomy

Laverde

Maak

Langheinrich

et al. 2023

JCM

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“…This is in accordance with the previous findings by Gupta et al, who found that symptom duration over two days had a significant impact on the need to convert to open surgery [ 15 ]. Different factors leading to conversion to open surgery have been evaluated, and age, male sex, obesity, diabetes, American Society of Anesthesiologists (ASA) scores, duration of symptoms, acute phase reactants, US findings, prior abdominal surgery, dense adhesions, diffuse peritonitis, difficulties in excision of the appendix due to perforation or severe inflammation, technical difficulties, inadequate exposure of appendix, surgeon's experience, intraoperative bleeding, iatrogenic bowel injuries, and other intraoperative complications are found to be associated with increased conversion rates [ 5 , 16 , 17 ]. Similar to the literature, the most common reasons for conversion are the inability to accurately recognize appendix and adhesions as a result of inflammation in this study [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Preoperative Imaging Features and Blood Tests in Predicting the Increased Risk of Conversion in Laparoscopic Appendectomy Surgery

Yiğit¹,

Cerekci²,

Cakir³

et al. 2021

Cureus

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Background In 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 methods The 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. Results Among 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). Conclusions Free 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.

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“…However, due to the serious oedema of local tissues, variation of the anatomical structures and doctors’ different proficiencies, acute complicated appendectomies are inevitably transferred to open surgery. Moreover, the conversion to a laparotomy for complicated appendices has been reported clinically to only be between 4.3% and 9.7% [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Application and curative effect of laparoscopic purse-string sutures in the treatment of adult acute complicated appendicitis

et al. 2023

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Objective To investigate the effect of laparoscopic purse-string sutures in adult complicated appendicitis treatment. Methods The data of 568 adult cases of complicated appendicitis treated by laparoscopic appendectomy at the Hefei Second People’s Hospital, Anhui Province, China, from September 2018 to September 2021 were analysed retrospectively. The patients were divided into two groups: 295 cases in the laparoscopic purse-string suture treatment group (observation group) and 273 cases in the simple Hem-o-lok® clamp treatment group (control group). The baseline data collected included age, gender, preoperative body temperature, leukocyte count and percentage of neutrophils and the surgery time. The postoperative data collected included antibiotic treatment duration, drainage tube placement time and the incidence of complications. Results There were no significant differences in the baseline data of the two groups, including age, gender, preoperative body temperature, leukocyte count and neutrophil percentage (all P > 0.05). Compared with the control group, the postoperative hospital length of stay, duration of antibiotic treatment, the recovery time of peripheral white blood cell and neutrophil counts and the incidence of postoperative complications in the observation group were significantly decreased (P < 0.05). Conclusion Purse-string sutures can effectively reduce the incidence of postoperative complications after a laparoscopic appendectomy for adult acute complicated appendicitis. There was faster postoperative recovery when patients’ appendiceal stumps were treated with laparoscopic purse-string sutures.

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The role of preoperative C-reactive protein value and neutrophil ratio in determination of conversion from laparoscopic appendectomy to open appendectomy

Cited by 5 publications

References 15 publications

Risk Factors for Conversion from Laparoscopic to Open Appendectomy

Risk Factors for Conversion from Laparoscopic to Open Appendectomy

Efficacy of Preoperative Imaging Features and Blood Tests in Predicting the Increased Risk of Conversion in Laparoscopic Appendectomy Surgery

Application and curative effect of laparoscopic purse-string sutures in the treatment of adult acute complicated appendicitis

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