Comparative Analysis of Open Versus Laparoscopic Appendectomy in the Management of Acute Appendicitis: A Prospective Comparative Study

Abstract

Background: Acute appendicitis remains the most common surgical emergency worldwide, and appendectomy is its definitive treatment. Although laparoscopic appendectomy (LA) has gained widespread acceptance, debate persists regarding its superiority over conventional open appendectomy (OA), particularly with respect to operative time, complications, and cost. This study compared the perioperative and postoperative outcomes of the two approaches.

Methods: A prospective comparative study was conducted on 120 patients with clinically and radiologically diagnosed acute appendicitis, allocated into two groups: LA (n = 60) and OA (n = 60). Outcomes assessed included operative time, intraoperative blood loss, postoperative pain (Visual Analogue Scale), analgesic requirement, time to resumption of oral intake, length of hospital stay, wound infection, intra-abdominal abscess, and time to return to normal activity. Data were analysed using Student's t-test and chi-square test; p < 0.05 was considered significant.

Results: Mean operative time was longer in the LA group (58.4 ± 12.6 min) than the OA group (46.2 ± 10.8 min; p < 0.001). However, LA was associated with significantly lower postoperative pain scores at 24 hours (3.1 ± 1.0 vs 5.2 ± 1.2; p < 0.001), earlier resumption of oral intake (14.6 ± 4.2 vs 22.8 ± 5.6 hours; p < 0.001), shorter hospital stay (2.4 ± 0.9 vs 4.1 ± 1.3 days; p < 0.001), lower wound infection rate (3.3% vs 13.3%; p = 0.048), and earlier return to normal activity (9.8 ± 2.4 vs 15.6 ± 3.5 days; p < 0.001). Intra-abdominal abscess rates did not differ significantly (3.3% vs 1.7%; p = 0.559).

Conclusion: Laparoscopic appendectomy, despite a modestly longer operative time, offers significant advantages in postoperative recovery, pain control, wound-related morbidity, and return to daily activity, and should be considered the preferred approach where laparoscopic expertise and equipment are available.