European Journal of Cardiovascular Medicine

Acute appendicitis is one of the most frequent surgical emergencies worldwide, with a lifetime risk estimated at 7–8% in the general population [1]. It predominantly affects young adults but can occur at any age, and timely surgical intervention is crucial to prevent complications such as perforation, peritonitis, and intra-abdominal abscess, which significantly increase morbidity and healthcare costs [2].

Open appendectomy, first performed in the late 19th century, has long been considered the standard treatment for acute appendicitis. It provides definitive removal of the appendix and remains widely practiced, particularly in resource-limited settings [3]. However, since the introduction of laparoscopic appendectomy in 1983, minimally invasive surgery has gained worldwide acceptance due to advantages such as smaller incisions, reduced postoperative pain, shorter hospital stay, quicker return to daily activities, and superior cosmetic results [4].

Despite these benefits, concerns remain regarding prolonged operative times, higher costs, and the potential risk of intra-abdominal abscess formation, especially in complicated appendicitis [5,6]. Multiple randomized and observational studies, as well as meta-analyses, have compared laparoscopic and open approaches, consistently demonstrating better short-term outcomes with laparoscopy, although open surgery still has relevance where laparoscopic facilities and expertise are limited [1–6].

Given these considerations, the present observational study was undertaken to compare the management and outcomes of laparoscopic versus open appendectomy in patients with acute appendicitis. The study focuses on operative parameters, postoperative recovery, complications, and short-term outcomes to provide practical insights for optimizing surgical decision-making in routine clinical practice.

Study Design and Setting

This was an observational, comparative study conducted in the Department of Surgery, Father Colombo Institute of Medical Sciences, Warangal, in collaboration with Medicare General Hospital, Warangal. The study was carried out over a period of three months, from November 2024 to January 2025.

Study Population

A total of 100 patients presenting with clinical features suggestive of acute appendicitis and subsequently undergoing appendectomy were included. Patients were divided into two groups based on the surgical approach: laparoscopic appendectomy (n = 50) and open appendectomy (n = 50).

Inclusion Criteria

• Patients aged ≥12 years diagnosed with acute appendicitis based on clinical evaluation and supportive imaging (ultrasonography or CT, when indicated).
• Patients who provided written informed consent for participation.

Exclusion Criteria

• Patients with generalized peritonitis or appendicular mass requiring interval appendectomy.
• Patients with significant co-morbid conditions contraindicating laparoscopy.
• Pregnant women.
• Patients unwilling to consent for the study.

Data Collection

Baseline demographic and clinical variables including age, gender, body mass index (BMI), duration of symptoms, and presence of co-morbidities were recorded. Operative details such as type of surgery, operative time, intraoperative blood loss, and need for conversion were documented. Postoperative outcomes including pain scores (Visual Analogue Scale at 24 hours), duration of hospital stay, time to return to daily activities, and postoperative complications were assessed. Patients were followed up for one month to evaluate recovery and short-term outcomes.

Ethical Considerations

The study protocol was reviewed and approved by the Institutional Ethics Committee of Father Colombo Institute of Medical Sciences. Written informed consent was obtained from all participants. Confidentiality of patient information was maintained, and no additional risk beyond routine surgical management was imposed.

Statistical Analysis

Data were entered into Microsoft Excel and analyzed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as mean ± standard deviation (SD) and compared between groups using the Student’s t-test. Categorical variables were expressed as frequencies and percentages, with comparisons performed using the chi-square test or Fisher’s exact test where appropriate. A p-value < 0.05 was considered statistically significant.

A total of 100 patients with acute appendicitis were included, equally divided into laparoscopic (n = 50) and open appendectomy groups (n = 50). The two groups were comparable with respect to demographic and baseline characteristics, including age, gender distribution, body mass index (BMI), duration of symptoms, and presence of co-morbidities, with no statistically significant differences observed (Table 1).

Table 1. Demographic and Baseline Characteristics of Patients (n = 100)

Intraoperative findings demonstrated that the mean operative time was longer in the laparoscopic group (65.4 ± 12.1 minutes) compared with the open group (58.2 ± 10.7 minutes, p = 0.001). However, the mean intraoperative blood loss was significantly lower in laparoscopic procedures (40.6 ± 15.2 ml) than in open surgery (75.8 ± 20.3 ml, p < 0.001). Conversion from laparoscopic to open appendectomy was required in 2 patients (4%) (Table 2).

Table 2. Operative Parameters

Postoperative recovery outcomes favored laparoscopic appendectomy. Patients in the laparoscopic group reported significantly lower pain scores at 24 hours (VAS 3.2 ± 0.9 vs. 5.6 ± 1.2, p < 0.001). The mean length of hospital stay was also shorter for laparoscopic surgery (3.1 ± 1.4 days) compared to open surgery (6.5 ± 2.0 days, p < 0.001). Similarly, the time to return to normal daily activities was faster in the laparoscopic group (9.2 ± 2.7 days) relative to the open group (14.6 ± 3.5 days, p < 0.001) (Table 3).

Table 3. Postoperative Recovery Outcomes

Figure 1. Postoperative Recovery Outcomes

The overall complication rate was lower in the laparoscopic group (10%) compared to the open group (22%), though this difference did not reach statistical significance (p = 0.08). Wound infection was the most frequent postoperative complication, occurring in 6% of laparoscopic cases and 16% of open cases. Intra-abdominal abscesses were identified in 2% and 4% of patients, respectively. Re-exploration was required in one patient from each group, and no mortality was observed. At one-month follow-up, complete recovery was achieved in 92% of patients undergoing laparoscopic surgery, significantly higher than the 78% observed in the open group (p = 0.04) (Table 4).

Table 4. Postoperative Complications and Outcomes

The present observational study compared laparoscopic and open appendectomy in patients with acute appendicitis. Our results confirm that laparoscopic appendectomy offers significant advantages in terms of reduced intraoperative blood loss, lower postoperative pain, shorter hospital stay, earlier return to daily activities, and improved short-term recovery, despite a modest increase in operative time.

In this study, mean operative duration was longer in the laparoscopic group, consistent with prior reports that highlighted longer surgical times due to technical complexity and the associated learning curve [6]. Nevertheless, the benefits in recovery parameters outweighed the extended operative duration. Importantly, blood loss was significantly lower in the laparoscopic group, supporting findings from previous studies that demonstrated reduced intraoperative bleeding with minimally invasive techniques [7].

Postoperative recovery parameters strongly favored laparoscopy. Patients reported lower pain scores and were discharged earlier, aligning with international evidence that laparoscopic appendectomy enhances recovery and reduces hospitalization [8,9]. Similarly, the return to daily activities was faster, underscoring the functional advantages of laparoscopy and echoing outcomes reported in large cohort analyses [10].

Although the overall complication rate was lower in the laparoscopic group, the difference did not reach statistical significance in this study. Wound infection was the most common complication, occurring more frequently in open appendectomy, consistent with evidence that smaller incisions in laparoscopy reduce the risk of surgical site infections [11]. Concerns regarding intra-abdominal abscess formation after laparoscopy were not substantiated in our cohort, as complication rates remained comparable between groups. Recent meta-analyses similarly indicate that the risk of intra-abdominal abscess is not significantly higher following laparoscopic surgery [12].

At one-month follow-up, functional recovery was significantly better in the laparoscopic group, with higher rates of complete recovery. These findings are in line with previous literature reporting superior cosmesis, higher patient satisfaction, and faster reintegration into normal life after laparoscopy [8,11]. Nonetheless, open appendectomy continues to hold clinical relevance, particularly in resource-limited settings or where laparoscopic expertise and facilities are not widely available [10].

Limitations

This study was limited by its single-center design, relatively small sample size, and short follow-up period of one month. Long-term outcomes such as chronic pain, incisional hernia, or recurrent abdominal symptoms were not assessed. Furthermore, cost analysis was not included, which may influence surgical decision-making in low-resource contexts.

This observational study highlights that laparoscopic appendectomy offers distinct advantages over the open technique in the management of acute appendicitis. Although operative time was slightly longer, the laparoscopic approach resulted in significantly less intraoperative blood loss, lower postoperative pain, shorter hospital stay, faster return to daily activities, and improved short-term recovery. Complication rates, particularly wound infections, were lower in the laparoscopic group, and functional outcomes at one month were superior. These findings support laparoscopy as the preferred surgical option when expertise and resources are available. Open appendectomy, however, continues to remain a valuable alternative in selected cases and resource-constrained settings.

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