Risk Factors for Conversion in Laparoscopic Appendicectomy: A Cross-Sectional Study in a Middle-Income Country

Abstract – Introduction: Acute appendicitis is a common surgical emergency. Laparoscopic appendicectomy is preferred for faster recovery and less pain, but conversion to open surgery remains necessary in some cases. Most evidence on conversion comes from high-income countries, while data from low- and middle-income settings (LMIC), where resource limitations may influence surgical decisions, are scarce. This study aimed to identify factors associated with conversion in a public, resource-limited Peruvian hospital. Methods: We conducted a retrospective cross-sectional study of patients undergoing laparoscopic appendicectomy at a public hospital in Lima, Peru, between 2022 and 2023. Variables were compared between patients requiring conversion and those completing the procedure laparoscopically. Multivariate analyses were performed to identify risk factors. Results: A total of 523 patients were included. Conversion to open appendicectomy occurred in 4 patients (0.76%), primarily due to difficult dissection from severe adhesions, intraoperative hemorrhage associated with equipment malfunction. Multivariate analysis identified adhesions (OR = 8.91, 95% CI: 1.48–53.42, p = 0.017), appendicolith (OR = 11.49, 95% CI: 1.74–75.69, p = 0.001), and intraoperative complications (OR = 45.74, 95% CI: 6.71–311.55, p < 0.001) as significant factors of conversion. Conclusions: Laparoscopic appendicectomy is safe and effective in public hospitals, even in low-resource settings. Conversion was rare and mainly driven by adhesions, appendicoliths, or intraoperative complications. These findings reinforce that laparoscopic appendicectomy can be reliably performed in LMIC.