Conversion from laparoscopic to open appendicectomy: a possible drawback of the laparoscopic technique?

Abstract

Objective: To analyse the reasons for, and outcome of, conversion from laparoscopic to open appendicectomy and to identify factors that may predict the need for conversion.

Design: Subgroup analysis from a randomised multicentre study.

Setting: One university hospital and four county hospitals, Sweden.

Subjects: A total of 500 patients were randomised to laparoscopic (n = 244) or open (n = 256) appendicectomy. Thirty operations (12%) were converted to open appendicectomy.

Main outcome measures: Reasons for conversion, outcome, and preoperative predictive variables.

Results: Difficult anatomy or the presence of an abscess were the main reasons for conversion (25/30). The incidence of perforated appendicitis was higher among patients who required conversion compared with both the open and laparoscopic group. Operating time, anaesthetic time, and duration of hospital stay were longer after conversion. Time to full recovery and length of sick leave were also longer, except for patients with perforated appendicitis. There was no difference in the complication rate. No predictive factors were identified.

Conclusion: The main reasons for conversion were difficult anatomy and the presence of an abscess. After conversion patients recovered more slowly than those operated on laparoscopically or by primary open operation.