In this study, investigators from the United States identified computed tomographic (CT) signs that predict possible failure of laparoscopic appendectomy.
The team evaluated 234 consecutive patients in whom laparoscopic appendectomy was attempted. Of these, 26 required conversion to open appendectomy.
|7% of patients with a CT inflammation grade of 0 to 3 required conversion.|
All patients underwent preoperative CT.
The team found that conversion was correlated with appendix location, appendicolith, cecal wall thickening involving the base of the appendix, lymphadenopathy, and appendiceal diameter.
They used a 6-point to grade to grade the inflammation:
- 0 = normal appendix
- 1 = possibly abnormal appendix (6mm diameter without other abnormality)
- 2 = abnormal appendix (diameter >6mm with wall enhancement) without adjacent fat stranding
- 3 = abnormal appendix surrounded by fat stranding
- 4 = abnormal appendix surrounded by fat stranding and fluid
- 5 = inflammatory mass or abscess.
The investigators found that there was a significant difference in appendiceal diameter between the patients in who underwent successful laparoscopic appendectomy, and those who required conversion. However, they were unable to identify a distinct cutoff point.
None of the 5 CT findings evaluated were found to be significant predictors of conversion to open appendectomy.
The team determined that 7% of patients with a CT inflammation grade of 0 to 3 required conversion, compared to 21% of patients with a grade of 4 or 5.
Dr Bettina Siewert's team concluded, "The majority of patients with appendicitis can be treated with laparoscopic appendectomy".
"Nevertheless, patients who require conversion to open appendectomy tend to have high CT inflammation grades of 4 or 5".