COMPARISON OF OPEN APPENDECTOMY VERSUS LAPAROSCOPIC APPENDECTOMY IN OBESE PATIENTS: A RANDOMIZED CONTROLLED TRIAL

Abstract

Objective
To compare the outcomes of laparoscopic appendectomy (LA) versus open appendectomy (OA) in obese patients with acute appendicitis, focusing on operative time, postoperative pain, hospital stay, and wound complications.

Methodology
A randomized controlled trial was conducted at the Department of Surgery over six months. A total of 112 obese patients (BMI >30 kg/m²) with a clinical diagnosis of acute appendicitis were enrolled and randomly assigned into two groups: Group L (LA, n=56) and Group O (OA, n=56). Patients were assessed for operative time, postoperative pain using the Visual Analogue Scale (VAS), length of hospital stay, and wound-related complications. Data were analyzed using SPSS version 25. Independent sample t-tests and Chi-square tests were used to compare outcomes. Stratification was done to control for effect modifiers including age, gender, and co-morbidities.

Results
The LA group had significantly lower postoperative pain at 6 hours (VAS 3.1 ± 1.0 vs. 5.6 ± 1.3, p<0.001) and at discharge (1.3 ± 0.8 vs. 3.4 ± 1.0, p<0.001), shorter hospital stays (1.5 ± 0.6 vs. 2.9 ± 1.1 days, p<0.001), and fewer wound complications (8.9% vs. 33.9%, p<0.001). However, operative time was longer in the LA group (56.3 ± 9.8 vs. 49.1 ± 10.5 minutes, p=0.001). Stratified analysis confirmed statistical significance across subgroups.

Conclusion
Laparoscopic appendectomy demonstrates superior outcomes in obese patients with acute appendicitis, making it the preferred surgical approach over open appendectomy despite slightly longer operative times.

Keywords
Laparoscopic appendectomy, open appendectomy, obesity, acute appendicitis, postoperative outcomes, wound complications, randomized controlled trial.

Background: Acute appendicitis is one of the most common surgical emergencies worldwide and appendectomy remains the standard treatment. The rising prevalence of obesity poses additional challenges for surgeons, as obese patients are at greater risk of wound complications, longer hospital stays, and delayed recovery following abdominal surgery. Laparoscopic appendectomy has gained recognition as a preferred approach due to reduced postoperative morbidity, yet its superiority over open appendectomy in obese patients continues to be debated.

Objective: To compare the outcomes of laparoscopic appendectomy (LA) and open appendectomy (OA) in obese patients with acute appendicitis, with emphasis on operative time, postoperative pain, hospital stay, and wound-related complications.

Methods: This randomized controlled trial was conducted in the Department of Surgery over six months. A total of 112 obese patients (BMI >30 kg/m²) with clinically and radiologically confirmed acute appendicitis were enrolled. Participants were randomly allocated into two equal groups: Group L underwent LA (n=56) and Group O underwent OA (n=56). Outcomes included operative time, postoperative pain at 6 hours and at discharge using the Visual Analogue Scale (VAS), hospital stay in days, and wound-related complications. Statistical analysis was performed using SPSS version 25. Independent sample t-tests and Chi-square tests were applied, with stratification by age, gender, and co-morbidities. A p-value of <0.05 was considered statistically significant.

Results: Patients in Group L experienced significantly less postoperative pain at 6 hours (3.1 ± 1.0 vs. 5.6 ± 1.3, p<0.001) and at discharge (1.3 ± 0.8 vs. 3.4 ± 1.0, p<0.001) compared with Group O. Mean hospital stay was shorter in the laparoscopic group (1.5 ± 0.6 vs. 2.9 ± 1.1 days, p<0.001). Wound complications occurred in 8.9% of Group L compared with 33.9% of Group O (p<0.001). The mean operative time was longer for LA (56.3 ± 9.8 vs. 49.1 ± 10.5 minutes, p=0.001). Stratified analysis confirmed significance across all subgroups.

Conclusion: Laparoscopic appendectomy demonstrated superior outcomes in obese patients with acute appendicitis, with less pain, fewer wound complications, and shorter hospital stay, making it the preferred surgical approach despite a slightly longer operative time.