title: Risk factors of converting to laparotomy in laparoscopic appendectomy for acute appendicitis.
abstract: OBJECTIVE
  Laparoscopic appendectomy (LA) for acute appendicitis has several advantages over open appendectomy (OA). In cases of complicated appendicitis, LA is converted to OA at a constant rate, though converting appendectomy (CA) has several disadvantages. We retrospectively determined preoperative risk factors for failure of LA and subsequent conversion to OA.
  
  
  METHODS
  Consecutive cases of preoperative computed tomography (CT) and attempted LA were retrieved from our hospital database and grouped by procedure (LA versus CA). Patients with negative appendectomies (n = 28), opened appendectomy (n = 210), delayed interval appendectomy (n = 3), or who were <14 years of age were excluded.
  
  
  RESULTS
  Average patient age, preoperative C-reactive protein (CRP) level, and diffuse peritonitis were significantly different between the groups. CT inflammation and occurrence of complicated appendicitis were significantly higher in CA than LA. Conversion to OA was mostly because of dense adhesions, diffuse peritonitis, and difficulties in excision of the appendix due to perforation or severe inflammation from surgical point of view. Postoperative complications were significantly lower in LA than CA, although the rate of intraoperative abscess was not different.
  
  
  CONCLUSIONS
  Most patients with acute appendicitis can be successfully treated with LA. We identified the following significant risk factors of CA: CT inflammation grade 4 or 5; complicated appendicitis; higher preoperative CRP level; and diffuse peritonitis.
authors.affiliation: Department of Surgery, Aso Iizuka Hospital, Iizuka City, Fukuoka, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Abe
authors.forename: Takashi
authors.initials: T
authors.lastname: Nagaie
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Miyazaki
authors.forename: Miho
authors.initials: M
authors.lastname: Ochi
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Fukuya
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kajiyama
keywords: acute appendicitis; laparoscopic appendectomy; laparotomy