OPEN VERSUS LAPAROSCOPIC APPENDECTOMY: A COMPARATIVE STUDY
DOI:
https://doi.org/10.71000/x8nbt767Keywords:
Appendectomy, Cross-Sectional Studies, Laparoscopy, Pain Measurement, Postoperative Complications, Surgical Blood Loss, Treatment OutcomeAbstract
Background: Acute appendicitis is one of the most frequent surgical emergencies globally, with appendectomy remaining the definitive treatment. Advances in minimally invasive surgery have positioned laparoscopic appendectomy as an alternative to the conventional open procedure, offering the potential for reduced morbidity, faster recovery, and improved patient comfort. However, open appendectomy continues to be practiced extensively, particularly in resource-limited settings. Comparative evaluation of both techniques is necessary to guide evidence-based surgical decision-making.
Objective: The objective of this study was to compare intraoperative and postoperative outcomes between open and laparoscopic appendectomy in patients with acute, non-perforated appendicitis.
Methods: An analytical cross-sectional study was conducted at General Hospital Lahore over four months, from April to July 2024. A total of 200 patients were enrolled and divided equally into two groups: Group A underwent open appendectomy and Group B underwent laparoscopic appendectomy. Intraoperative outcomes included operative time and blood loss, while postoperative outcomes included pain scores at the fourth hour and incidence of intra-abdominal abscess within three weeks of follow-up. Pain was measured using the visual analogue scale (VAS), blood loss was recorded in milliliters, and suspected abscesses were confirmed via ultrasound. Data were analyzed using SPSS version 23, with a p-value of <0.05 considered significant.
Results: The mean operative time was shorter in the open appendectomy group, while laparoscopic appendectomy resulted in significantly lower intraoperative bleeding (25.6 ± 36.2 mL vs. 6.9 ± 6.5 mL). Postoperative pain scores were higher in the open group (mean VAS 6.5 ± 0.87) compared to the laparoscopic group (mean VAS 4.5 ± 0.87). Intra-abdominal abscess formation occurred in 3 patients (3%) in the open group and 5 patients (5%) in the laparoscopic group.
Conclusion: Laparoscopic appendectomy demonstrated superiority in terms of reduced bleeding and postoperative pain, whereas open appendectomy showed advantages of shorter operative time and fewer abscesses. Surgical decision-making should remain patient-centered, taking into account individual physiology, disease complexity, and institutional resources.
References
Klein T, Diesbach D, Boemers TM, Vahdad RM. Transumbilical laparoscopic-assisted appendectomy in children and adolescents: what have we learnt in more than 1200 cases? Langenbecks Arch Surg. 2024;409(1):263.
Alganabi M, Biouss G, Pierro A. Surgical site infection after open and laparoscopic surgery in children: a systematic review and meta-analysis. Pediatr Surg Int. 2021;37(8):973-81.
Liu F, Lv Q, Wang CY, Li ZW, Liu XR, Peng D. Single-port laparoscopic appendectomy using new surgical procedure versus conventional three-port laparoscopic appendectomy. Updates Surg. 2024;76(4):1347-55.
Noitumyae J, Mahatharadol V, Niramis R. Single-Incision Pediatric Laparoscopic Surgery: Surgical Outcomes, Feasibility Indication, and the Systematic Review. J Laparoendosc Adv Surg Tech A. 2022;32(11):1190-202.
Zhou Y, Rastegar V, Read TE, Al-Mansour MR. Safety of Laparoscopic Appendectomy in the Setting of Coagulopathy: An ACS-NSQIP Study. J Surg Res. 2022;275:103-8.
Khirallah MG, Elsossuky NE, Ghazaly M. Predictive factors of post-laparoscopic appendectomy peritoneal collection in children and adolescents with complicated appendicitis. Afr J Paediatr Surg. 2021;18(4):190-4.
Zhong A, Short C, Sundin A, Austin C, Gao L, Tabarsi E, et al. Postoperative narcotic utilization in single incision laparoscopic-assisted extracorporeal appendectomy (SILEA): a single-institution retrospective review. Pediatr Surg Int. 2022;38(12):1997-2003.
Carlson S, Batra S, Billow M, El-Nashar SA, Chapman G. Perioperative Complications of Laparoscopic versus Open Surgery for Pelvic Inflammatory Disease. J Minim Invasive Gynecol. 2021;28(5):1060-5.
Hussein AH, El-Baaly A, Ghareeb WM, Madbouly K, Gabr H. Outcome and quality of life in obese patients underwent laparoscopic vs. open appendectomy. BMC Surg. 2022;22(1):282.
Iglesias NJ, Arrowood R, Montgomery L, Leeper E, Tsao KJ, Iglesias JL. Operative Time Is Independently Associated With Morbidity in Pediatric Complicated Appendicitis. J Surg Res. 2022;276:143-50.
Lipping E, Saar S, Rull K, Tark A, Tiiman M, Jaanimäe L, et al. Open versus laparoscopic appendectomy for acute appendicitis in pregnancy: a population-based study. Surg Endosc. 2023;37(8):6025-31.
Okamoto N, Sujishi K, Tsugawa S, Jin L, Suzuki T, Waseda M. Needlescopic appendectomy versus conventional laparoscopic appendectomy in young patients. Asian J Endosc Surg. 2023;16(2):241-7.
Kiblawi R, Zoeller C, Zanini A, Kuebler JF, Dingemann C, Ure B, et al. Laparoscopic versus Open Pediatric Surgery: Three Decades of Comparative Studies. Eur J Pediatr Surg. 2022;32(1):9-25.
Neogi S, Banerjee A, Panda SS, Ratan SK, Narang R. Laparoscopic versus open appendicectomy for complicated appendicitis in children: A systematic review and meta-analysis. J Pediatr Surg. 2022;57(3):394-405.
Li Y, Guo Z, Qu Z, Rong L, Hong M, Chi S, et al. Laparoscopic simultaneous inguinal hernia repair and appendectomy in children: A multicenter study. J Pediatr Surg. 2022;57(8):1480-5.
Cirocchi R, Cianci MC, Amato L, Properzi L, Buononato M, Di Rienzo VM, et al. Laparoscopic appendectomy with single port vs conventional access: systematic review and meta-analysis of randomized clinical trials. Surg Endosc. 2024;38(4):1667-84.
Nepal YJ, Paudyal S, Shah S, Giri N. Laparoscopic Appendectomy versus Open Appendectomy in Acute Appendicitis. J Nepal Health Res Counc. 2023;20(4):825-9.
Valinoti AC, Dreifuss NH, Angeramo CA, Schlottmann F. Laparoscopic Appendectomy Performed by Surgical Interns: Is it Too Early? Surg Laparosc Endosc Percutan Tech. 2020;31(2):223-6.
Oweira H, Elhadedy H, Reissfelder C, Rahberi N, Chaouch MA. Irrigation during laparoscopic appendectomy for complicated appendicitis increases the operative time and reoperation rate: a meta-analysis of randomized clinical trials. Updates Surg. 2021;73(5):1663-72.
Nikolovski A, Ulusoy C. Intra and Postoperative Advantages of Laparoscopy in the Treatment of Complicated Appendicitis. Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2022;43(2):59-65.
Delgado-Miguel C, Miguel-Ferrero M, San Basilio M, Ramírez C, Camps J, Hernández Oliveros F. How does the number of training years in pediatric surgery affect appendectomy outcomes? Pediatr Surg Int. 2023;39(1):168.
Xu, H., et al. (2023). "Comparison of the efficacy and safety of antibiotic treatment and appendectomy for acute uncomplicated appendicitis: a systematic review and meta-analysis." BMC surgery 23(1): 208.
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Copyright (c) 2025 Anas Jahangir, Muhammad Haseeb , Muhammad Fiaz Mukhtiar, Atia ur Rehman, Anmol Arif , Muhammad Tahir Latif , Muhammad Shoaib Nadir (Author)
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