European Journal of Cardiovascular Medicine

Acute appendicitis is one of the most common surgical emergencies worldwide, requiring prompt diagnosis and treatment to prevent complications such as perforation and peritonitis (1). Appendicectomy remains the definitive management, with two primary approaches: open appendicectomy (OA) and laparoscopic appendicectomy (LA). Since its introduction in 1983 by Semm, LA has gained popularity due to its minimally invasive nature and potential benefits, including reduced postoperative pain, shorter hospital stays, and faster recovery times (2,3).

Despite these advantages, the superiority of LA over OA remains a subject of debate, particularly in resource-limited settings where surgical expertise and equipment availability may vary (4). OA has traditionally been the standard approach, offering direct access to the inflamed appendix through a lower abdominal incision. It is often preferred in cases of complicated appendicitis or when laparoscopic facilities are unavailable (5). However, OA is associated with a higher risk of wound infections, prolonged hospital stays, and increased postoperative pain (6).

In contrast, LA provides improved visualization, less tissue trauma, and a lower incidence of postoperative complications such as wound infections and ileus (7,8). However, concerns regarding longer operative times, higher costs, and the potential for increased intra-abdominal abscess formation have limited its universal adoption (9). Several studies have compared the two techniques, yielding mixed results regarding operative duration, recovery time, and overall patient outcomes (10).

Given the ongoing debate, this study aims to compare LA and OA in terms of operative time, postoperative complications, pain scores, and hospital stay duration. The findings will provide insights into the most effective and safe surgical approach for acute appendicitis in different clinical settings.

Study Design and Setting

This prospective, comparative study was conducted at a tertiary care hospital over a period of six months.

Study Population

A total of 100 patients diagnosed with acute appendicitis were included in the study. Patients were randomly assigned into two groups:

• Laparoscopic Appendicectomy (LA) Group (n=50)
• Open Appendicectomy (OA) Group (n=50)

Inclusion criteria comprised patients aged 18–60 years with a clinical and radiological diagnosis of acute appendicitis. Patients with complicated appendicitis (perforation, abscess, or gangrenous appendix), severe comorbidities, or contraindications to laparoscopy were excluded.

Surgical Procedure

Laparoscopic Appendicectomy (LA): The procedure was performed using a three-port technique under general anesthesia. Pneumoperitoneum was created, and the appendix was identified, mobilized, and removed using endoscopic staplers or ligatures.

Open Appendicectomy (OA): A standard McBurney’s incision was made in the right lower quadrant. The appendix was isolated, ligated, and excised. The abdominal wall was closed in layers.

Data Collection and Outcome Measures

Patient demographics, operative time, intraoperative complications, postoperative pain (assessed using the Visual Analog Scale), length of hospital stay, and postoperative complications such as surgical site infections (SSIs) and intra-abdominal abscess formation were recorded.

Statistical Analysis

Data were analyzed using SPSS software (version 25.0). Continuous variables were presented as mean ± standard deviation (SD) and compared using the independent t-test. Categorical variables were analyzed using the chi-square test. A p-value < 0.05 was considered statistically significant.

A total of 100 patients diagnosed with acute appendicitis were included in the study, with 50 patients undergoing laparoscopic appendicectomy (LA) and 50 undergoing open appendicectomy (OA). The demographic characteristics of the study population, including age, gender, and BMI, were comparable between the two groups, with no statistically significant difference (p > 0.05) (Table 1).

Operative and Postoperative Outcomes

The mean operative time was significantly higher in the LA group (45 ± 5 minutes) compared to the OA group (35 ± 6 minutes) (p = 0.03). However, postoperative pain scores, measured using the Visual Analog Scale (VAS), were lower in the LA group (3.2 ± 1.1) than in the OA group (5.1 ± 1.4) (p < 0.01) (Table 2).

The incidence of surgical site infections (SSIs) was significantly lower in the LA group (4%) compared to the OA group (12%) (p = 0.04). The mean hospital stay was also shorter in the LA group (2.3 ± 0.5 days) than in the OA group (4.1 ± 0.7 days) (p < 0.01) (Table 3).

Table 1. Demographic Characteristics of the Study Population

Table 2. Operative Time and Postoperative Pain

Table 3. Postoperative Outcomes

These findings suggest that laparoscopic appendicectomy, despite requiring a longer operative time, offers significant advantages in terms of reduced postoperative pain, shorter hospital stays, and lower complication rates compared to open appendicectomy.

This study compared laparoscopic appendicectomy (LA) and open appendicectomy (OA) in terms of operative duration, postoperative pain, hospital stay, and complications. The findings indicate that while LA requires a longer operative time, it provides significant benefits, including reduced postoperative pain, shorter hospital stays, and lower infection rates. These results align with previous studies that have demonstrated the advantages of laparoscopic surgery over open techniques in appendicectomy (1,2).

The increased operative time observed in the LA group (45 ± 5 minutes) compared to the OA group (35 ± 6 minutes) can be attributed to the technical complexity and the need for pneumoperitoneum creation (3). However, several studies suggest that with increased surgeon experience, the operative time for LA can be reduced, making it comparable to OA (4,5). Despite the longer duration, the benefits of LA in terms of faster recovery and reduced morbidity outweigh the slight increase in operative time (6).

Postoperative pain, assessed using the Visual Analog Scale (VAS), was significantly lower in the LA group (3.2 ± 1.1) than in the OA group (5.1 ± 1.4) (p < 0.01). This can be explained by the minimally invasive nature of laparoscopic surgery, which results in less tissue trauma and lower inflammatory responses (7). Previous research has also demonstrated that patients undergoing LA require fewer analgesics postoperatively, further supporting the pain-reducing effect of the laparoscopic approach (8,9).

Hospital stay was significantly shorter in the LA group (2.3 ± 0.5 days) compared to the OA group (4.1 ± 0.7 days) (p < 0.01). Studies have consistently reported that patients who undergo laparoscopic procedures have a quicker return to normal activities, reduced hospital costs, and lower rates of prolonged hospitalization (10,11). Shorter hospital stays also reduce the risk of nosocomial infections, making LA a more favorable option in modern surgical practice (12).

The incidence of surgical site infections (SSIs) was significantly lower in the LA group (4%) compared to the OA group (12%) (p = 0.04). This finding aligns with prior studies that have shown a reduced risk of wound-related complications in laparoscopic procedures due to smaller incisions and less exposure of intra-abdominal contents to external contaminants (13). Additionally, the lower SSI rate in LA has been attributed to improved visualization and precise tissue handling, which minimizes the risk of bacterial contamination (14).

Despite its benefits, LA has some limitations, including higher costs associated with laparoscopic instruments, the requirement for specialized surgical expertise, and the potential for intra-abdominal abscess formation, particularly in cases of complicated appendicitis (15). However, with technological advancements and increasing laparoscopic experience, these concerns are gradually being addressed, making LA a preferred choice in many healthcare settings (16).

Overall, the findings of this study support the growing evidence that LA is a superior alternative to OA for uncomplicated appendicitis. However, patient selection, surgeon expertise, and healthcare resources should be considered when choosing the surgical approach. Future studies with larger sample sizes and long-term follow-up are recommended to further evaluate the benefits and potential complications of laparoscopic appendicectomy.

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