TO STUDY OF PREOPERATIVE FACTORS RESPONSIBLE FOR CONVERSION OF LAPAROSCOPIC APPENDECTOMY TO OPEN APPENDECTOMY BY PREOPERATIVE CLINICAL EXAMINATION AND ULTRASONOGRAPHY

DR. J.P.S. SHAKYA; Dr. ARUN RATHORE; Dr. SACHIN SHUKLA

Volume : X, Issue : I, January - 2020

TO STUDY OF PREOPERATIVE FACTORS RESPONSIBLE FOR CONVERSION OF LAPAROSCOPIC APPENDECTOMY TO OPEN APPENDECTOMY BY PREOPERATIVE CLINICAL EXAMINATION AND ULTRASONOGRAPHY

Dr. J. P. S. Shakya, Dr. Arun Rathore, Dr. Sachin Shukla

Abstract :

OBJECTIVE:In our study objective is to identified 5 independent risk factor for conversion of laparoscopic appendicectomy are Duration of illness,History of Previous surgery,Leucocyte count at the time of diagnosis,Ultrasonography and Intraoperative findings Materials and methods: Study from December 2017 to December 2019. appendectomy for acute appendicitis was performed on 60 patients in our Surgical Unit at Sarojni Naidu Medical College, Agra. Of these, 30 patients underwent laparoscopic appendicectomy and 30 patients underwent open appendicectomy The clinical, demographic, surgical and pathological data of these patients were included in a prospective database.. The following factors were analyzed in order to identify which were associated with the conversion: History of Previous abdominal surgery, Leucocyte count at the time of diagnosis, preoperative Ultrasonography, Intraoperative findings and Duration of illness During our study period. Results: At univariate analysis, the factors significantly related to the conversion were the presence of Intraoperative findings (50%) has been the most common factor, preoperative ultrsasonography findings for conversion in(20%)cases, (10%) had undergone previous abdominal surgery , Leucocyte count at the time of diagnosis have no effect on conversion in Duration of illness>3 days (20%)have laparoscopic appendectomies, (30%) laparoscopic appendectomies converted to open . Duration of illness<3 days (30%)have laparoscopic appendectomies and ( 20% )laparoscopic appendectomies converted to open. Conclusion: The majority of patients with acute appendicitis can be successfully managed with laparoscopy. We found that the only preoperative independent factor related to conversion during laparoscopic appendectomy is the presence of preoperative factors . Nevertheless surgeons should take into account that presence of Intraoperative findings( peri–appendicular abscess) and pre operative ultrsasonography findings ( diffuse peritonitis) are both independently related not only to higher rate of conversion but also to higher risk of postoperative complication. Duration of illness and history of undergone previous abdominal surgery also factors for coversion but on lesser rate.