Published: 2020-05-26

Laparoscopic versus open appendicectomy: a non-randomized comparative study

Swatej Hanspal, M. Yunus Shah, Murtaza Akhtar


Background: Appendicectomy is one of the most common surgical procedures performed in emergency surgery. Despite this, there is still lack of consensus about the most appropriate technique for appendicectomy. In this longitudinal analysis, we aimed to compare the outcomes of laparoscopic appendicectomy (LA) and the conventional technique or open appendicectomy (OA) in the treatment of acute appendicitis.

Methods: A non-randomized longitudinal comparative study was conducted in NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, India. From November 2017 to October 2019, 53 patients underwent OA and 59 underwent LA, making a total number of patients included in this study to be 112 (n). The two groups were compared for operative time, length of hospital stay, postoperative pain, post-operative ileus and complication rate.

Results: Laparoscopic appendicectomy was associated with a shorter hospital stay (4.34±1.37 days in LA and 5.09±1.71 days in OA, p<0.01), with a lower post operative pain score [VAS] (2.93±0.80 in LA and 4.62±0.92 in OA, p<0.001). Operative time was shorter in the open group (42.70±12.05 min in OA and 43.39±16.59 in LA). Complications were lesser in the LA group with a significantly lower incidence of wound infection (3.4% in LA and 13.2% in OA).

Conclusions: Laparoscopic approach is safe and efficient in appendicectomy and it provides clinically advantages over open method (shorter hospital stays, lower post op pain, early food tolerance, earlier return to work and lesser wound infection) against only marginally longer operative time.


Laparoscopic appendicectomy, Open appendicectomy, Appendicitis

Full Text:



Adiss DG, Shaffer N, Fowler BS. The epidemiology of appendicitis and appendicectomy in the United States. Am J Epidemiol. 1990;132:910-25.

Connell PR. The Vermiform Appendix. In:Norman WS, Christopher JKB, O. C. P. (eds. ). Bailey and Love Short Practice of Surgery.

Chung RS, Rowland DY, Li P, Diaz J. A meta-analysis of randomized controlled trials of laparoscopic versus conventional appendectomy. Am J Surg. 1999;177:250-6.

Garbutt JM, Soper NJ, Shannon W, Botero A, Littenberg B. Meta-analysis of randomized controlled trials comparing laparoscopic and open appendectomy. Surg Laparosc Endosc. 1999;9:17-26.

Fogli L, Brulatti M, Boschi S, Domenico DM, Papa V, Patrizi P, et al. Laparoscopic appendectomy for acute and recurrent appendicitis: retrospective analysis of a single-group 5 years experience. J Laparoendosc Adv Surg Tech A. 2002;12:107-10.

Agresta F, Simone DP, Leone L, Arezzo A, Biondi A, Bottero L, et al. Italian Society of Young Surgeons (SPIGC). Laparoscopic appendectomy in Italy: an appraisal of 26,863 cases. J Laparoendosc Adv Surg Tech A. 2004;14:1-8.

Bhangu A, Soreide K, Saverio DS, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet. 2015;386:1278-87.

Saverio DS, Mandrioli M, Birindelli A, Biscardi A, Donato DL, Gomes CA, et al. Single-Incision Laparoscopic Appendectomy with a Low-Cost Technique and Surgical-Glove Port: ‘How To Do It’ with Comparison of the Outcomes and Costs in a Consecutive Single-Operator Series of 45 Cases. JACS. 2016;222(3):15-30.

Saverio DS. Emergency laparoscopy: a new emerging discipline for treating abdominal emergencies attempting to minimize costs and invasiveness and maximize outcomes and patients’ comfort. J Trauma Acute Care Surg. 2014;77:338-50.

Reddy A, Nichkaode PB. Study of Laparoscopic versus Open Appendicectomy. Indian J Med Sci. 2012;66(5-6):99-115.

Kathare SS, Nandkishor DS, Ahmed F, Ahmed A. Comparative study of open versus laparoscopic appendicectomy. Int J Surg Sci. 2019;3(3):131-6.

Horvath P, Lange J, Bachmann R. Comparison of clinical outcome of laparoscopic versus open appendectomy for complicated appendicitis. Surg Endosc. 2017;31:199-205.

Kurtz RJ, Heimann TM. Comparison of open and laparoscopic treatment of acute appendicitis. Am J Surg. 2001;182:211-4.

Katkhouda N, Mason RJ, Towfigh S, Gevorgyan A, Essani R. Laparoscopic versus open appendectomy: a prospective randomized double-blind study. Ann Surg. 2005;242:439-48.

Ignacio RC, Burke R, Spencer D, Bissell C, Dorsainvil C, Lucha PA. Laparoscopic versus open appendectomy: what is the real difference? Results of a prospective randomized double-blinded trial. Surg Endosc. 2004;18:334-7.

Kehagias I, Karamanakos SN, Panagiotopoulos S, Panagopoulos K, Kalfarentzos F. Laparoscopic versus open appendectomy: which way to go. World J Gastroenterol. 2008;14:4909-14.

Jaschinski T, Mosch C, Eikermann M, Neugebauer EA. Laparoscopic versus open appendectomy in patients with suspected appendicitis: a systematic review of meta-analyses of randomised controlled trials. BMC Gastroenterol. 2015;15:48.

Sauerland S, Jaschinski T, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2010;10:CD001546.

Thakre S. A Comparative Study between Laparoscopic Appendectomy and Conventional Open Appendectomy. Sch J App Med Sci. 2014;2(5):1909-12.

Ciftci F. Laparoscopic vs mini-incision open appendectomy. World J Gastrointest Surg. 2015;7(10):267-72.

Biondi, Antonio. Laparoscopic versus open appendectomy: a retrospective cohort study assessing outcomes and cost-effectiveness. World J Emergency Surgery. WJES. 2016;11:1-44.

Alejandro. Cost-effectiveness of laparoscopic versus open appendectomy in developing nations: a Colombian analysis Ruiz-Patino. J Surg Res. 2017;224:33-7.