Beyond the incisions: unraveling the superiority between laparoscopic versus open appendectomy

Authors

  • Mohammad Tarequl Islam Department of General Surgery, Combined Military Hospital, Chattogram, Bangladesh
  • M. Mahboob Hasan Department of General Surgery, Combined Military Hospital, Chattogram, Bangladesh
  • Sohel Ahmed Department of General Surgery, Combined Military Hospital, Chattogram, Bangladesh
  • Abul Kalam Basir Department of General Surgery, Combined Military Hospital, Chattogram, Bangladesh
  • Fahmida Hasnat Department of Obstetrics and Gynecology, Combined Military Hospital, Chattogram, Bangladesh

DOI:

https://doi.org/10.18203/2349-2902.isj20232322

Keywords:

Appendicitis, Laparoscopic appendectomy, Open appendectomy, Post-operative outcome

Abstract

Background: Appendectomy is one of the most common surgical emergencies worldwide and is performed using either an open or a laparoscopic approach. Although minimally invasive surgeries are replacing open surgical procedures, laparoscopic appendectomy (LA) has not yet been established as the gold standard procedure compared to open appendectomy (OA). This study aimed to compare the outcomes of LA and OA in 100 cases and evaluate the feasibility, safety, and efficacy of LA as the preferred method for treating acute appendicitis.

Methods: This study was a prospective comparative analysis of 100 patients with acute appendicitis who underwent LA or OA. This study was conducted at a tertiary care hospital (CMH Chattogram) between January 2021 and April 2023. Patients were divided into two groups: laparoscopic (n=50) and open (n=50) appendectomy. Both groups were compared for operative time, length of hospital stay, postoperative pain, complication rate, time to return to normal activity, and cosmetic outcome.

Results: The mean operative time was significantly longer in the LA group (43 minutes) compared to the OA group (36.4 minutes) (p<0.001). However, the LA group had significantly less postoperative pain with a mean VAS score of 2.04 at 48 hours postoperatively compared to 5.7 in the OA group(p<0.001). LA group had a shorter length of hospital stay compared to the OA group (3.12 days versus 6.48 days, p<0.001) and a faster time to return to normal activities (7.68 days versus 16.58 days, p<0.001). the LA group had less surgical site infection compared to the open group, with 2 out of 50 compared to 8 in the open group (p<0.46). The cosmetic outcome was measured with the scar scale where the LA group had a significantly better-looking scar with a score of 4.28 versus the score of 8.86 (p<0.001) in the case of the OA group.

Conclusions: While the longer operative time of LA was a drawback, its benefits in terms of the better visual field of vision during operation and improved patient outcomes make it the more favorable option for appendectomy.

References

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

McBurney C. Experience with early operative interference in cases of disease of the vermiform appendix”. NY Med J. 1889;50:676-84.

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

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.

Ortega AE, Hunter JG, Peters JH, Swanstrom LL, Schirmer B. A prospective, randomized comparison of laparoscopic appendectomy with open appendectomy. Laparoscopic Appendectomy Study Group. Am J Surg. 1995;169:208-12.

Milewczyk M, Michalik M, Ciesielski M. A prospective, randomized, unicenter study comparing laparoscopic and open treatments of acute appendicitis. Surg Endosc. 2003;17:1023-8.

Bresciani C, Perez RO, Habr-Gama A, Jacob CE, Ozaki A, Batagello C, et al. Laparoscopic versus standard appendectomy outcomes and cost comparisons in the private sector. J Gastrointest Surg. 2005;9:1174-80.

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.

Golub R, Siddiqui F, Pohl D. Laparoscopic versus open appendectomy: a meta-analysis. J Am Coll Surg. 1998;186:545-53.

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.

Hart R, Rajgopal C, Plewes A, Sweeney J, Davies W, Gray D, et al. Laparoscopic versus open appendectomy: a prospective randomized trial of 81 patients. Can J Surg. 1996;39:457-62.

Im GY, Modayil RJ, Lin CT, Geier SJ, Katz DS, Feuerman M, et al. The appendix may protect against Clostridium difficile recurrence. Clin Gastroenterol Hepatol. 2011;9(12):1072-7.

Laurin M, Everett ML, Parker W. The cecal appendix: one more immune component with a function disturbed by post-industrial culture. Anat Rec. 2011;294(4):567-79.

Bollinger RR, Barbas AS, Bush EL, Lin SS, Parker W. Biofilms in the large bowel suggest an apparent function of the human vermiform appendix. J Theor Biol. 2007;249(4):826-31.

Buia A, Stockhausen F, Hanisch E. Laparoscopic surgery: a qualified systematic review. World J Methodol. 2015;5(4):238-54.

Aftab H, Amarjeet E, Gajanan V, Ajay H, Ahana G. Laparoscopic versus open appendectomy: a prospective comparative study and 4-year experience in a tertiary care hospital. Surg J. 2022;8:e208-14.

Rashid A, Nazir S, Kakroo SM, Chalkoo MA, Razvi SA, Wani AA. Laparoscopic interval appendectomy versus open interval appendectomy: a prospective randomized controlled trial. Surg Laparosc Endosc Percutan Tech. 2013;23(01):93-6.

Sauerland S, Lefering R, Neugebauer E. Laparoscopic versus open surgery for suspected appendicitis (review). Cochrane Database Syst Rev. 2004;4:CD001546.

Zhang G, Wu B. Meta-analysis of the clinical efficacy of laparoscopic appendectomy in the treatment of acute appendicitis. World J Emerg Surg. 2022;17(1):26.

Guller U, Hervey S, Purves H, Muhlbaier LH, Peterson ED, Eubanks S, et al. Laparoscopic versus open appendectomy: outcomes comparison based on a large administrative database. Ann Surg. 2004;239(1):43-52.

Downloads

Published

2023-07-28

Issue

Section

Original Research Articles