A recent internal review of a community-based hospital system revealed a 19.19% rate of conversion from a laparoscopic appendectomy to an open procedure. This study examined the preoperative risk factors for failed laparoscopic appendectomy requiring a conversion to a laparotomy.

A total of 198 patients presented with perforated appendicitis. Perforation was defined as a computed tomography (CT) scan interpretation, pathology findings, or surgical findings. Of these patients, 161 underwent a laparoscopic appendectomy or laparoscopy converted to an open procedure. The preoperative risk factors in the two groups were compared through a retrospective chart review.

Through multivariant analysis, age greater than 45 was the greatest risk factor for the need to convert to an open procedure with an odds ratio (OR) of 3.51. A CT scan read of perforation was associated with a significant 2.65 OR. The C-reactive protein was 19.82 mg/L in the failed laparoscopic cases and 9.96 mg/L in the laparoscopic cases.

Patients older than 45 years old with a CT radiologist’s read of a perforation in multivariant analysis have an increased risk of failed laparoscopic surgery requiring conversion to open surgery.

This study identifies the optimal incision site by describing the relationship between McBurney’s point and the base of appendix using the coronal view of abdominal multi-detector computed tomography (MDCT) in patients with acute appendicitis.

We reviewed the records of 206 patients with positive MDCT findings who were histologically diagnosed with acute appendicitis after appendectomy between January 2014 and September 2015. The outer 1/3 point between two points, the umbilicus and the right anterior superior iliac spine, was marked as McBurney’s point on the coronal view. The superoinferior, mediolateral and radial distances between the base of appendix and McBurney’s point were measured and recorded.

The average age was 35.1±20.3 years. There were 34 patients below the age of 15-years-old (children), and 172 patients over 15-years-old (adults). In 35.4% of patients, the base of appendix was located within a radius of 2 cm from the McBurney’s point, in 39.8% it was within 2∼4 cm, and in 24.8% was over 4 cm. The average center coordinate of the base of inflamed appendix in our patients is 9.32 mm, 8.31 mm and the distance between two points is 12.5 mm.

The location of appendix has wide individual variability; therefore the McBurney’s point has limitations as an anatomic landmark. If we choose to customize appendectomy incisions considering the base of appendix by using an abdominal MDCT coronal view, additional incision site extension can be reduced.

Research comparing the effectiveness of different doses of antibiotics prior to surgery for preventing infection is sparse. This study examines whether a single dose of preoperative antibiotics suffices to treat uncomplicated appendicitis via laparoscopic appendectomy.

This study retrospectively reviewed the medical records of 149 patients who underwent laparoscopic appendectomy from July 2013 to December 2014 in a single institution. The participants were divided into two groups; group A (n=99) was given a single dose of prophylactic antibiotics before surgery, and group B (n=50) was given both preoperative and postoperative antibiotics. Clinical factors and surgical outcomes were compared between two groups.

The mean length of hospital stay for group A (2.5 days) was shorter than for group B (3.2 days) (p<0.001). Average operation time was 58.7 minutes for group A, longer than for group B (52.2 minutes, p=0.027). There was no difference in pathologic results and postoperative complications, such as surgical site infection (SSI) between the two groups. In groups A and B, 4.0% of patients had superficial SSIs. One patient (2.0%) in group B had deep/organ SSI.

A single dose of prophylactic antibiotics administration to patients undergoing laparoscopic appendectomy is acceptable as a treatment in uncomplicated appendicitis.