Comparative Outcomes of Laparoscopic Versus Open Appendectomy for Acute Appendicitis: A Tertiary Hospital-Based Study

Abstract

Background: Acute appendicitis is a leading cause of emergency abdominal surgery worldwide, and in South Asian tertiary hospitals. Laparoscopic appendectomy is widely adopted due to advantages in pain control, earlier feeding and ambulation, shorter hospital stays, and lower wound infection, although operative time and local system factors may influence outcomes. The study aims to compare outcomes between laparoscopic and open appendectomy for acute appendicitis in a tertiary hospital in Bangladesh.

Methods: This comparative observational study was conducted at Sir Salimullah Medical College & Mitford Hospital, which enrolled 160 consecutive patients with intraoperatively confirmed acute appendicitis; 80 underwent laparoscopic appendectomy, and 80 underwent open appendectomy based on surgeon preference and feasibility. Baseline assessment included clinical features and timing, WBC, neutrophil percentage, CRP, and imaging, ultrasonography routinely and CT selectively, with comorbidities and ASA class recorded. Standard laparoscopic three-port and conventional open techniques were used, with selective drain placement, conversion, and intraoperative events documented. Outcomes included 24-hour pain score, opioid use, time to oral intake and ambulation, antibiotic duration, length of stay, complications, and 30-day readmission, reoperation, and mortality. Analyses used SPSS v26 with appropriate comparative tests and p<0.05 as significant.

Results: Baseline characteristics and preoperative clinical, laboratory, and imaging findings were comparable between groups. Laparoscopic appendectomy required longer operative time than open appendectomy (55 ± 18 vs 42 ± 15 minutes, p<0.001), with a 6.3% conversion rate. Postoperative recovery favored laparoscopy, including lower 24-hour pain scores (3.6 ± 1.4 vs 4.5 ± 1.6, p<0.001), reduced opioid requirement (27.5% vs 50.0%, p=0.006), earlier oral intake (11.2 ± 4.6 vs 15.0 ± 5.2 hours, p<0.001) and ambulation (13.5 ± 5.3 vs 18.4 ± 6.0 hours, p<0.001), shorter antibiotic duration (2.1 ± 1.5 vs 3.0 ± 1.8 days, p<0.001), and shorter hospital stay (2.5 ± 1.0 vs 3.4 ± 1.3 days, p<0.001). Overall complications were lower with laparoscopy (10.0% vs 22.5%, p=0.052), and surgical site infection was significantly reduced (2.5% vs 12.5%, p=0.032). Readmission and reoperation rates were low and similar, with no mortality in either group.

Conclusion: Laparoscopic appendectomy provided superior early recovery compared with open appendectomy, with less pain and opioid use, earlier feeding and ambulation, shorter antibiotic courses, and reduced hospital stay, despite longer operative time. Morbidity was lower, particularly surgical site infection, while major complications, readmission, reoperation, and mortality were comparable between approaches.