Comparison of Outcomes of Laparoscopic vs Open Appendectomy in Complicated Appendicitis in Adults: A Prospective Observational Comparative Study
Keywords:
Laparoscopic appendectomy, complicated appendicitis, intra-abdominal abscess, minimally invasive surgery.Abstract
Introduction: The role of laparoscopic appendectomy in complicated appendicitis remains controversial because of concerns regarding operative difficulty and postoperative infectious complications. This study evaluated and compared the outcomes of laparoscopic and open appendectomy in patients with complicated appendicitis.
Methods: A prospective observational comparative study was conducted over two years in a tertiary care hospital in Dhaka, Bangladesh. Adult patients diagnosed with acute appendicitis were prepared for laparoscopic appendectomy. During laparoscopy, those found to have complicated appendicitis were enrolled in the laparoscopic appendectomy (LA) group. Patients with uncomplicated acute appendicitis underwent conventional laparoscopic appendectomy and were not included in the study. Pre-operatively diagnosed complicated appendicitis patients were enrolled in the open appendectomy (OA) group. The primary outcome measure was postoperative intra-abdominal abscess (IAA) formation. Secondary outcomes included operative duration, postoperative hospital stay, wound infection, conversion rate, morbidity, readmission, and procedural cost.
Results: A total of 48 patients were enrolled, 34 patients in the laparoscopic group and 14 in the open surgery group. IAA occurred in 6.7% of LA vs 10% of OA (p=0.34). Operative time was longer in LA (75±20 vs 60±18 min; p<0.01). The LA group had shorter hospital stay (3.2±1.1 vs 4.8±1.5 days; p<0.001). Wound infection was lower in LA (4% vs 12.5%; p=0.03). Conversion to open was necessary in five patients (14.7%) of LA. Although the laparoscopic approach involved slightly higher procedural costs and required prolonged operation time, it demonstrated superior postoperative recovery and shorter hospital stay.
Conclusion: Laparoscopic appendectomy for complicated appendicitis is a safe and effective surgical option associated with lower wound infection rates, shorter hospitalization, and acceptable postoperative complication rates. In experienced hands, laparoscopic surgery should be considered a preferred approach in selected patients with complicated appendicitis.
Journal of Surgical Sciences 2024;28(1): 28-35
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