Risk factors for additional port insertion in single-port laparoscopic appendectomy

Introduction
Single-port laparoscopic appendectomy (SPLA) was expected to have reduced risk of wound infection, less postoperative pain, and improved patient’s satisfaction with better cosmesis compared with conventional laparoscopic appendectomy (CLA). When SPLA is converted to CLA, the additional incision for another port insertion can lead to a decrease in the surgical advantages and clinical benefit.

Aim
To evaluate risk factors for conversion to CLA during SPLA.

Material and Methods
Between August 2015 and December 2016, patients who underwent intended SPLA were retrospectively reviewed. Conversion was defined as any insertion of an additional port, and complicated appendicitis was defined as gangrenous or perforated appendicitis, abscess, or peritonitis in preoperative computed tomography. Postoperative complication was defined as any deviation in the routine postoperative course within 30 days postoperatively.

Results
Of 409 patients, 65 (15.9%) were treated with additional port insertion. The overall complication rate was 1.5% in each group, of which 1 patient developed superficial SSI and 4 patients developed deep surgical site infections in the SPLA group. After univariable and multivariable analysis, old age, male sex, increased serum C-reactive protein (OR = 2.944; 95% CI: 1.433–6.047; p = 0.003), and complicated appendicitis (OR = 3.330; 95% CI: 1.304–8.503; p = 0.012) were significant risk factors for conversion to CLA.

Conclusions
The conversion rate to CLA was 15.9%. Serum C-reactive protein level and complicated appendicitis were strong predictive factors for conversion from SPLA in acute appendicitis.