Comparison of laparoscopic and open appendectomy outcomes in acute appendicitis

Objective: This study aimed to compare the intraoperative and postoperative outcomes of laparoscopic appendectomy (LA) and open appendectomy (OA) in patients diagnosed with acute appendicitis, with a focus on surgical outcomes and recovery parameters. Methods: A retrospective analysis was conducted on 376 patients who underwent appendectomy for acute appendicitis at İzmir City Hospital between October 15, 2023, and August 15, 2024. Patients were grouped based on surgical approach (LA or OA). Data on demographic characteristics, body mass index (BMI), operative duration, intraoperative blood loss, time to oral intake, length of hospital stay, return-to-work time, and postoperative complications were collected and analyzed. Statistical significance was defined as p < 0.05. Results: Of the 376 patients, 251 underwent LA and 125 underwent OA. The mean operative duration was significantly longer in the LA group (102.56 ± 44.4 minutes vs. 85.4 ± 43.11 minutes, p = 0.009). However, intraoperative blood loss was significantly lower in the LA group (29.64 ± 62.97 mL vs. 74.79 ± 168.55 mL, p = 0.018). Postoperative pain scores (VAS) were significantly lower in LA patients, and they experienced a shorter hospital stay and faster return to work (p < 0.001). The incidence of wound infections was lower in the LA group compared to the OA group (5% vs. 12%, p = 0.03). Conversion from LA to OA occurred in 2.9% of cases due to intraoperative complications such as bleeding, perforation, or inadequate visualization. Conclusion: Laparoscopic appendectomy demonstrated favorable postoperative outcomes compared to open appendectomy, including reduced postoperative pain, shorter hospital stays, and quicker recovery. These results support the adoption of LA as a safe and effective alternative to OA, particularly in patients with higher BMI or less severe disease presentations. Nonetheless, larger prospective randomized studies are required to confirm these findings and better define the optimal indications for LA in clinical practice.