Predictors for Conversion to Open Appendicectomy in Patients Undergoing Laparoscopic Appendicectomy for Acute Appendicitis

Background: Laparoscopic appendicectomy (LA) is widely preferred for acuteappendicitis due to reduced postoperative pain, faster recovery, and lower woundinfection rates. However, conversion to open appendicectomy (OA) may occur due tointraoperative challenges. Identifying preoperative predictors of conversion couldoptimize surgical planning and patient outcomes.Objective: This study aimed to identify preoperative factors predicting conversionfrom LA to OA in patients with acute appendicitis.Methods: A prospective study was conducted at SS Institute of Medical Sciences andHospital, Davangere, from January 2023 to December 2024. Sixty patients undergoingLA were evaluated. Parameters including age, sex, comorbidities, ASA grading,Tzanaki’s score, leukocyte count, and ultrasound findings were analyzed. Conversionrates and associated factors were assessed using chi-square tests, with significance setat p<0.05.Results: Of 60 patients, 12 (20%) required conversion to OA. Significant predictorsincluded age ≥40 years (66.67% conversion, p=0.0001), comorbidities (90.90%conversion, p=0.0001), ASA grade >2 (88.89% conversion, p=0.001), Tzanaki’s score≤9 (52.38% conversion, p=0.02), and leukocyte count >12,000/mm³ (36% conversion,p=0.02). Sex showed no significant association (p=0.95).Conclusion: Preoperative factors such as advanced age, comorbidities, higher ASAgrade, lower Tzanaki’s score, and leukocytosis reliably predict conversion to OA.These findings suggest a preoperative scoring system could guide surgical approachselection, reducing operative time and costs.