European Journal of Cardiovascular Medicine

Acute appendicitis represents one of the most frequent abdominal emergencies worldwide, necessitating prompt surgical intervention to avoid complications such as perforation or peritonitis (1,2). Appendectomy is recognized as the definitive treatment, with two primary surgical methods utilized: open appendectomy (OA) and laparoscopic appendectomy (LA) (3,4). Historically, OA has been the conventional surgical approach, characterized by straightforward technique, lower cost, and extensive surgical exposure; however, it is associated with increased postoperative pain, prolonged recovery, and higher infection rates (5,6).

In recent decades, LA has gained popularity as a minimally invasive technique offering several advantages, including shorter hospital stays, reduced postoperative discomfort, faster return to normal activities, and improved cosmetic outcomes (7–9). Despite these apparent benefits, debate continues regarding the comparative efficacy of laparoscopic versus open approaches, particularly concerning postoperative complications like wound infections and intra-abdominal abscess formation (10,11).

Postoperative wound infection remains a significant complication after appendectomy, prolonging hospitalization, increasing healthcare costs, and adversely affecting patient outcomes (12). Various studies have reported differing infection rates following appendectomy, with some suggesting lower infection risk with LA, while others have found comparable or even contradictory results (13–15). Given these inconsistencies, additional research is essential to clearly define and substantiate the relative risk of postoperative infections between these two surgical techniques.

Thus, this study aims to investigate and compare postoperative wound infection rates between open and laparoscopic appendectomy procedures, providing clarity on the optimal surgical approach and helping to refine clinical practice guidelines.

This retrospective comparative study was conducted at a tertiary healthcare facility over a period of one year. 

A total of 300 patients who underwent appendectomy due to acute appendicitis during the study duration were included and classified into two groups based on the surgical method used: laparoscopic appendectomy (LA, n=150) and open appendectomy (OA, n=150). Inclusion criteria consisted of patients aged between 15 and 60 years, diagnosed clinically and radiologically with acute appendicitis, and undergoing emergency appendectomy procedures. Patients presenting with appendiceal perforation, generalized peritonitis, pregnancy, or underlying immunosuppressive conditions were excluded to avoid confounding factors.

Patient data were retrospectively collected from electronic medical records and included demographic variables (age, gender, body mass index), clinical presentation, comorbid conditions, surgical details (duration of surgery, intraoperative complications), and postoperative outcomes. The primary outcome measure was the incidence of postoperative wound infections, defined by clinical evidence of infection such as erythema, swelling, discharge, tenderness at the surgical site, and/or positive wound cultures taken during clinical assessment. Secondary outcome variables included length of hospital stay, recorded in days.

Statistical analysis was performed using SPSS version 26 (IBM Corp., Armonk, NY, USA). Categorical variables were expressed as frequencies and percentages, while continuous variables were reported as means and standard deviations. Chi-square tests were used to evaluate differences in categorical data, including infection rates, while the independent samples t-test was utilized to compare continuous variables such as hospital stay duration. Logistic regression analysis was performed to identify potential predictors associated with wound infection. A p-value of less than 0.05 was considered statistically significant.

A total of 300 patients were evaluated, comprising two equal groups: laparoscopic appendectomy (LA, n=150) and open appendectomy (OA, n=150). Both groups exhibited similar demographic profiles with respect to age, gender distribution, and presence of comorbid conditions (Table 1).

Table 1: Demographic and Clinical Characteristics of Patients (n=300)

The overall postoperative wound infection rate was significantly lower in the laparoscopic appendectomy group compared to the open appendectomy group. Specifically, 6 patients (4%) in the LA group developed postoperative wound infections compared to 18 patients (12%) in the OA group (p=0.011; Table 2). The logistic regression analysis further supported this finding, identifying open surgical technique as a significant predictor of postoperative wound infection (OR: 3.28, 95% CI: 1.28–8.43, p=0.013).

Table 2: Comparison of Postoperative Outcomes between LA and OA groups (n=300)

In addition, patients in the LA group had significantly shorter hospital stays compared to the OA group (2.3 ± 0.7 days versus 4.1 ± 1.2 days; p<0.001). However, the operative time was notably longer for the LA group (48.5 ± 11.2 minutes) when compared to the OA group (42.3 ± 10.5 minutes; p<0.001), as shown in Table 2.

The findings of this study indicate that laparoscopic appendectomy (LA) is associated with a significantly reduced postoperative wound infection rate compared to open appendectomy (OA), reinforcing the benefits of minimally invasive approaches in surgical practice. This result aligns with multiple prior studies that have similarly documented lower infection rates following laparoscopic procedures, attributing these findings to reduced incision size, minimal tissue trauma, and diminished exposure of the surgical wound to contaminants (1–3).

In the present analysis, postoperative wound infection occurred in 4% of the patients who underwent laparoscopic surgery versus 12% in the open appendectomy group. These findings are consistent with other comparative trials, which have reported postoperative infection rates ranging from 2–6% for laparoscopic appendectomy compared to 10–15% for open surgery (4–6). Lim et al. specifically highlighted a substantial reduction in wound infection in complicated appendicitis cases treated laparoscopically, underscoring LA’s benefit in managing higher-risk patients (7).

Interestingly, despite lower infection rates, the mean operative time was slightly increased in the laparoscopic group compared to open surgery. This finding is supported by other authors, who have suggested that the technical complexity and setup required for laparoscopy may lead to prolonged operating times (8,9). However, the clinical significance of this difference remains minimal, especially given the improved patient outcomes in terms of infection control and overall recovery.

The shorter hospital stay observed among patients undergoing laparoscopic appendectomy is another advantage supported extensively in the literature (10–12). Reduced hospitalization is not only beneficial from the patient's perspective—facilitating quicker return to daily activities—but also economically advantageous due to lower overall healthcare expenditures (13,14). The reduced incidence of complications like wound infections plays a crucial role in shortening hospitalization periods.

While the advantages of laparoscopic surgery are evident, certain factors must be acknowledged when generalizing these results. For instance, selection biases inherent in retrospective studies might impact outcomes, as surgeons may preferentially select laparoscopic techniques for less complicated or more favorable patient presentations (15). Furthermore, surgeon experience significantly affects complication rates and operative duration, a variable that was not specifically controlled for in the current study (6,15).

Future studies should ideally adopt prospective randomized designs to reduce bias and control for potential confounders, such as surgeon proficiency and severity of appendicitis presentation. Additionally, evaluation of cost-effectiveness and patient-reported outcomes could further strengthen evidence supporting laparoscopic appendectomy as a routine practice.

In conclusion, laparoscopic appendectomy consistently demonstrates superiority over open appendectomy concerning postoperative wound infection rates and duration of hospitalization. These benefits underline the necessity for broader implementation of minimally invasive surgery techniques, especially for managing common surgical emergencies such as acute appendicitis.

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