Laparoscopic Management of Complicated Appendicitis: Two years experience in a tertiary care hospital in Dhaka, Bangladesh

Background: The role of laparoscopic appendectomy (LA) in complicated appendicitis (CA) remains debated due to concerns over infectious complications and operative difficulty. This study prospectively compared outcomes between laparoscopic and open appendectomy in CA. Methods: Over two years, adults presenting with diagnosis of acute appendicitis were assigned to LA or open appendectomy (OA). Primary endpoint was postoperative intra-abdominal abscess (IAA). Secondary endpoints included operative time, conversion rate, hospital stay, wound infection, morbidity and cost. Results: Of 90 patients, 62 underwent LA and 28 OA. 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). 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 11.3% of LA. Average procedural cost was 15% higher for LA. Conclusion: Laparoscopic appendectomy in complicated appendicitis demonstrates favorable outcomes in terms of lower IAA rates, significantly lower wound infection, and shorter hospitalization compared to open surgery. LA should be considered first-line in CA when performed by skilled surgeons.