A comparative study of laparoscopic appendectomy versus open appendectomy

Reina Khadilkar, Ashwini Anil Panditrao, Ramteja Inturi


Background: Obstruction of appendiceal lumen resulting in acute appendicitis is diagnosed by clinical examination, supported by raised neutrophil count, computed tomography and/or ultrasonography.Appendectomy one of the most commonly done surgeries is the standard line of management for acute appendicitis. Trend is towards greater utilization of laparoscopic appendectomy despite lack of consensus on superiority of laparoscopic procedure, hence imperative to prove scientifically the effectiveness of the two methods. The aim of the present study was a comparative study of laparoscopic appendectomy versus open appendectomy.

Methods: A prospective cohort study of 100 cases of acute appendicitis above 16 years of age with no co morbidities was carried out in Dr. D. Y. Patil Medical College, Hospital and Research Centre from July 2017 to September 2019.

Results: Mean age was 28.82 years, 64 (64%) males and 36 (36%) females, pain in abdomen (100%) being most common complaint followed by fever (77%) with positive correlation with severity of appendicitis (Alvarado score) and with total leukocyte count. Mean duration of surgery and hospital stay in laparoscopic appendectomy was lesser than open and difference was statistically highly significant (p=0.000). No difference in pain score observed. Retrocaecal (58%) was the most common position, slightly higher rate of complications in open appendectomy, no conversion of laparoscopic to open. Subjective level of satisfaction score (0-10) in laparoscopic appendectomy was higher than in open and difference was statistically highly significant (p=0.000).

Conclusions: Laparoscopic appendectomy had advantages like better cosmesis, shorter duration of procedure and hospital stay, fewer post-operative complications and early return to work with disadvantage of steep learning curve, while open appendectomy, does not require special instruments, and is performed under direct three-dimensional vision.


Acute appendicitis, Open appendectomy, Laparoscopic appendectomy

Full Text:



Meljnikov I, Radojcić B, Grebeldinger S, Radojcić N. History of surgical treatment of appendicitis. Med Pregl. 2009;62(9-10):489-92.

Graffeo CS, Counselman FL. Appendicitis. Emerg Med Clin North Am. 14(4):653–71.

Wangensteen OH, Bowers WF. Significance of the obstructive factor in the genesis of acute appendicitis. Arch Surg. 1937;34(3):496–526.

Pieper R, Kager L, Tidefeldt U. Obstruction of vermiform appendix causing acute appendicitis. An experimental study in the rabbit. Acta Chirurgica Scandinavica. 1982;148(1):63–72.

Hollerman J, Bernstein MA, Kottamasu SR, Sirr SA. Acute recurrent appendicitis with appendicolith. Am J Emerg Med. 1988;6(6):614–7.

Dehghan A, Moaddab AH, Mozafarpour S. An unusual localization of trichobezoar in the appendix. Turk J Gastroenterol. 2011;22(3):357–8.

Shogilev DJ, Duus N, Odom SR, Shapiro NI. Diagnosing appendicitis: evidence-based review of the diagnostic approach in 2014. West J Emerg Med (Review). 2014;15(7):859-71.

Terasawa T, Blackmore CC, Bent S, Kohlwes RJ. Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med. 2004;141(7):537–46.

Kulik DM, Uleryk EM, Maguire JL. Does this child have appendicitis?. A systematic review of clinical prediction rules for children with acute abdominal pain. J Clin Epidemiol. 2013;66(1):95–104.

Ellis H. Acute appendicitis. Br J Hospital Med. 2012;73 (3):C46–8.

Appendicitis. Available at: Accessed on

GBD 2013 Mortality Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2015;385(9963):117–71.

Barrett ML, Hines AL, Andrews RM. Trends in Rates of Perforated Appendix, 2001–2010 (PDF). Healthcare Cost and Utilization Project (HCUP) Statistical Brief #159. Rockville, MD: Agency for Healthcare Research and Quality. 2013: 24199256.

Lauren M, Hao Y, Pamela LO, Raynard W. Overview of Children in the Emergency Department, 2010. Healthcare Cost and Utilization Project Statistical Brief #157 (Report). Agency for Healthcare Research and Quality. 2013.

Chaudhari YP, Jawale PG. Prevalence of appendicitis at surgery inpatient department of a tertiary care hospital: a descriptive study. Med Pulse Int Med J. 2015;2(11):768-70.