Comparative Observational Study of Open versus Laparoscopic Appendectomy in Acute Appendicitis

Background: Appendectomy continues to be one of the most common procedures in general surgery, accounting for approximately 1% of all surgical operations. Laparoscopic appendectomies (LAs) are likely to have less post-operative pain, early discharge, decreased wound infection, better cosmesis and also diagnostic and early return to routine work. This study aimed to compare the outcomes between open and laparoscopic approaches in appendectomy. Materials and Methods: This was a prospective, comparative observational study (non-randomised study) conducted at our institution from July 2018 to July 2020. A total of 106 patients who were admitted to the department of general surgery with the clinical and radiological diagnosis of acute appendicitis were included in the study after applying the inclusion and exclusion criteria. Fifty-three patients underwent LA and 53 patients underwent open appendectomy (OA). All the patients were followed every day in the post-operative period till they were discharged and then later followed for 4 weeks in our outpatient department. The following parameters, such as post-operative pain, post-operative complications, duration of the hospital stay, return to work and cosmetic benefit, were analysed. Results: We found that 11.3% of patients in the OA group had a severe pain score, whereas 0% of patients in the LA group had a severe pain score. 22.6% in the OA group and 4.1% in the LA group had post-operative fever. 6.1% in the LA group and 20.8% in the OA group have post-operative vomiting. 4.1% of the LA group had wound infection, whereas 22.6% of the OA group had wound infection. The mean hospital stay score was 2.29 days in the LA group and 4.91 days in the OA group. The return to routine work was 8.02 days in LA and 15.45 days in the OA group. 85.7% in the LA group and 54.7% in the OA group were fully satisfied with the cosmetic results. 2% in the LA group and 9 (17%) in the OA group were not satisfied with the surgeries. 92.5% of patients underwent successful LA, whereas 7.5% of patients were unsuccessful and converted back to open technique. Hence, the conversion rate in our hospital is 7.5%. There was a statistically significant difference seen in pain score, duration of use of analgesics, post-operative complications such as vomiting, fever and wound infection rate, duration of hospital stay, return to normal work and cosmetic benefits in both the groups. Conclusion: We conclude that the LA was better than the OA concerning pain score, lesser use of analgesics and post-operative complications such as vomiting, fever and wound infection rate. Post-operative recovery was good with respect to duration of hospital stay, return to normal work and cosmetic benefits. The conversion rate in our study is 7.5%, and the most common reason for conversion was severe adhesion.