Predictive Factors for Conversion From Single Incision Appendectomy to Multiport Appendectomy for Pediatric Acute Appendicitis: A Single-Center, Retrospective Cohort Study

Abstract

Introduction

Single-incision appendectomy (SIA), including laparoscopic and laparoscopic-assisted techniques, offers superior cosmetic outcomes and is increasingly applied to both uncomplicated and complicated cases of acute appendicitis. In our practice, transumbilical laparoscopic-assisted appendectomy is the initial approach for all patients with acute appendicitis. This retrospective cohort study aimed to identify risk factors associated with conversion from SIA to multiport appendectomy (MPA).

Methods

We retrospectively reviewed medical records of patients aged < 15 years who underwent appendectomy for acute appendicitis at our hospital between April 2018 and June 2025. Patients were categorized into two groups: the SIA group and the MPA group, based on whether the procedure was completed as SIA or required conversion to MPA. Perioperative variables were compared between the groups.

Results

A total of 129 patients were included in this study. Of these, 79 (61.2%) were in the SIA group and 50 (38.8%) were in the MPA group. Univariate analysis revealed significant intergroup differences in preoperative C-reactive protein (CRP) levels, maximal appendiceal diameter on preoperative imaging, time from symptom onset to hospital visit (> 24 h), and sex. Multivariate exploratory stepwise logistic regression analysis identified elevated preoperative CRP levels (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.03–1.21; p = 0.009) and female sex (OR, 2.72; 95% CI, 1.23–6.04; p = 0.014) as independent risk factors for conversion.

Conclusion

Elevated preoperative CRP levels and female sex were significantly associated with difficulty in completing SIA; larger prospective studies are warranted to validate these findings.