Department of Surgery, Saint Barnabas Medical Center, Livingston, New Jersey 07039, USA.
J Surg Res. 2012 Jul;176(1):42-9. doi: 10.1016/j.jss.2011.07.019. Epub 2011 Aug 5.
The role of laparoscopy in appendicitis has gained increased popularity but remains controversial. Despite more than 20 y of experience in laparoscopy, the nationwide laparoscopic appendectomy (LA) conversion rate is reportedly 8.6%. We sought to analyze the impact of patient-specific and surgeon-specific factors that may contribute to open conversion during LA.
A retrospective analysis of 745 LAs (49.9% females and 50.1% males; average age of 37.8 y performed at a large tertiary community teaching hospital over a 5-y period (May 2004-October 2008) was performed.
The overall conversion rate for the study period was 4.16% (n = 31). The most common reason for open conversion was severe acute inflammation (38.7%). Among converted cases, 77.42% had no prior abdominal surgery and only 25.81% of cases were converted due to adhesions. Females and patients ≥ 65-y-old had a higher likelihood of open conversion (4.30% versus 4.02%, P < 0.99 and 9.26% versus 3.76%, P < 0.1107). The overall conversion rate of cases performed by high-volume surgeons (≥ 50 total cases) in comparison to low-volume surgeons (10-49 total cases) was higher (4.86% versus 3.30%, P < 0.39). Conversion rates were lower among surgeons who completed residency training after 1990 (3.72% versus 4.35%, P < 0.82) and those with fellowship training (1.42% versus 5.18%, P < 0.034).
Laparoscopic conversion continues to gain popularity and remains the gold standard procedure for appendectomy. Older patients have a higher likelihood of conversion with severe acute inflammation being the most common reason for conversion. Additional minimally invasive fellowship training was the only surgeon-specific factor that significantly impacted conversion rate.
腹腔镜在阑尾炎中的应用越来越受到重视，但仍存在争议。尽管腹腔镜技术已经应用了 20 多年，但全国范围内腹腔镜阑尾切除术（LA）的中转率仍高达 8.6%。本研究旨在分析可能导致 LA 中转开腹的患者特异性和术者特异性因素。
对一家大型三级社区教学医院在 5 年内（2004 年 5 月至 2008 年 10 月）进行的 745 例 LA （49.9%为女性，50.1%为男性；平均年龄 37.8 岁）的回顾性分析。
研究期间的总中转率为 4.16%（n=31）。中转开腹的最常见原因是严重的急性炎症（38.7%）。在中转病例中，77.42%无既往腹部手术史，仅 25.81%的病例因粘连而中转。女性和≥65 岁的患者中转开腹的可能性更高（4.30%与 4.02%，P＜0.99 和 9.26%与 3.76%，P＜0.1107）。与低年资术者（10-49 例）相比，高年资术者（≥50 例）的总手术量中转率更高（4.86%与 3.30%，P＜0.39）。1990 年后完成住院医师培训的术者（3.72%）和接受过 fellowship 培训的术者（1.42%）的中转率较低（4.35%与 5.18%，P＜0.034）。
腹腔镜转化仍在普及，并且仍然是阑尾切除术的金标准。年龄较大的患者中转开腹的可能性更高，严重的急性炎症是中转的最常见原因。额外的微创 fellowship培训是唯一显著影响中转率的术者特异性因素。
