Acute appendicitis remains one of the most common causes of acute abdominal pain requiring emergency surgical intervention worldwide [1]. Traditionally, open appendectomy (OA) has been the gold standard for treatment since its first description in the late 19th century. However, with the advancement of minimally invasive surgical techniques, laparoscopic appendectomy (LA) has gained increasing acceptance as an alternative approach [2]. Each technique offers distinct advantages and potential limitations in terms of clinical outcomes, cost-effectiveness, recovery time, and complication rates [3].

Laparoscopic appendectomy offers benefits such as reduced postoperative pain, shorter hospital stays, earlier return to daily activities, and lower rates of wound infection [4,5]. On the other hand, it may be associated with longer operative times, higher equipment costs, and a learning curve that can impact surgical efficiency and patient safety [6]. In contrast, open appendectomy, although more invasive, provides quicker access in  

Complicated cases and remains the preferred method in resource-limited settings or where laparoscopic infrastructure is lacking [7].

Several studies have attempted to evaluate the comparative efficacy and safety of LA versus OA in both uncomplicated and complicated appendicitis, yet the choice of technique often remains surgeon-dependent and institution-specific [8]. Furthermore, factors such as patient age, body mass index (BMI), comorbidities, and severity of inflammation may influence surgical decision-making and outcomes [9].

This comparative study aims to assess and contrast the intraoperative and postoperative outcomes of laparoscopic versus open appendectomy in patients presenting with acute appendicitis. The objective is to generate real-world clinical insights that may guide surgical choice, optimize patient care, and inform policy on resource allocation in emergency surgical practice [10].

This comparative observational study was conducted in the Department of General Surgery at a tertiary care teaching hospital over a period of 18 months. The study was approved by the institutional ethics committee, and informed consent was obtained from all participants.

A total of 100 patients diagnosed with acute appendicitis based on clinical presentation, laboratory investigations, and imaging (ultrasound and/or CT scan) were enrolled. Patients were divided into two equal groups of 50 each: Group A underwent laparoscopic appendectomy (LA), while Group B underwent open appendectomy (OA). Allocation was based on the attending surgeon’s discretion and patient consent.

Inclusion criteria were age between 18 and 60 years, clinical diagnosis of acute appendicitis, and fitness for surgery under general anesthesia. Patients with generalized peritonitis, appendicular mass, pregnancy, previous lower abdominal surgeries, or unfit for general anesthesia were excluded.

All procedures were performed by experienced surgeons following standard protocols. Operative time, intraoperative findings, and any complications were recorded. Postoperative outcomes including duration of hospital stay, wound infection, postoperative pain (measured by Visual Analogue Scale at 6, 12, and 24 hours), and time to return to normal activities were documented.

Data were analyzed using SPSS version 25.0. Continuous variables were expressed as mean ± standard deviation and compared using the Student’s t-test. Categorical variables were analyzed using Chi-square test or Fisher’s exact test as appropriate. A p-value < 0.05 was considered statistically significant.

A total of 100 patients diagnosed with acute appendicitis were included in the study, with 50 patients each undergoing laparoscopic appendectomy (Group A) and open appendectomy (Group B). The mean age in Group A was 29.4 ± 8.7 years, while in Group B it was 30.1 ± 9.2 years (p = 0.68). Both groups had comparable gender distribution, with no significant difference in baseline demographics (Table 1).

Operative findings revealed that the mean operative time was significantly longer in the laparoscopic group (62.8 ± 10.5 minutes) compared to the open group (48.3 ± 9.6 minutes; p < 0.001). However, mean intraoperative blood loss was significantly lower in the laparoscopic group (p = 0.003). There were no major intraoperative complications in either group (Table 2).

In terms of postoperative outcomes, patients in the laparoscopic group experienced significantly lower pain scores at 12 and 24 hours post-surgery (VAS: 3.2 ± 0.8 vs. 5.1 ± 1.1 at 24 hours; p < 0.001), shorter mean hospital stay (2.6 ± 0.9 vs. 4.2 ± 1.3 days; p < 0.001), and earlier return to routine activities (6.1 ± 1.5 vs. 9.3 ± 2.0 days; p < 0.001) (Table 3).

Postoperative complications such as wound infection occurred in 2% of laparoscopic cases versus 10% in the open group (p = 0.04). No cases of intra-abdominal abscess or reoperation were reported in either group (Table 4).

Table 1. Baseline Demographic Profile of Patients

Table 2. Intraoperative Parameters

Table 3. Postoperative Recovery Parameters

Table 4. Postoperative Complications

The present study aimed to compare laparoscopic appendectomy (LA) and open appendectomy (OA) in the management of acute appendicitis, focusing on intraoperative and postoperative outcomes. Our findings demonstrate that while LA had a longer operative time, it offered significant benefits in terms of reduced blood loss, less postoperative pain, shorter hospital stay, and earlier return to daily activities.

The increased operative time for LA observed in this study is consistent with previous literature and is often attributed to the need for port placement, pneumoperitoneum creation, and intracorporeal dissection techniques [11,12]. However, this slight increase in duration is counterbalanced by the notable advantages in recovery parameters. Multiple studies have highlighted that LA results in decreased postoperative pain scores and reduced need for analgesics, aligning with our findings [13,14].

Hospital stay was significantly shorter in the laparoscopic group, a benefit consistently reported in meta-analyses and randomized trials comparing the two approaches [15]. Early mobilization and quicker return to work or daily activities are pivotal in minimizing the socioeconomic burden of appendicitis, especially in young, working-age populations [16].

Our study found a lower incidence of postoperative wound infections in the LA group, which supports the hypothesis that smaller incisions and reduced tissue handling minimize contamination risk [17]. Although wound infection is a relatively minor complication, it can considerably affect patient satisfaction and recovery.

The absence of major intra-abdominal complications or reoperations in either group indicates that both techniques are safe when performed by trained surgeons. However, several authors advocate for LA as the preferred method in uncomplicated appendicitis due to its minimally invasive nature and better cosmetic outcomes [18,19].

Nonetheless, OA may still be appropriate in certain clinical contexts—such as when equipment is unavailable, in cases of dense adhesions, or in low-resource settings. Surgeon experience and patient comorbidities should be taken into account when selecting the surgical approach [20].

Overall, this comparative study reinforces the growing body of evidence favoring laparoscopic surgery for uncomplicated appendicitis while acknowledging that open surgery remains a reliable and necessary technique under specific conditions.

Laparoscopic appendectomy, despite a longer operative time, offers significant advantages over open appendectomy in terms of reduced blood loss, postoperative pain, hospital stay, and wound complications. These findings support the preferential use of LA in eligible patients with acute appendicitis. However, OA still holds value in specific surgical scenarios where laparoscopic facilities or expertise are limited. Surgical choice should thus be individualized based on clinical, institutional, and patient-specific factors.

1. Azılı C, Tokgöz S, Chousein B, Tamam S, Benk MŞ, Culcu S, et al. Determination of risk factors for conversion from laparoscopic to open appendectomy in patients with acute appendicitis. Ulus Travma Acil Cerrahi Derg. 2023 Oct;29(10):1103-1108. doi: 10.14744/tjtes.2023.94955. PMID: 37791447; PMCID: PMC10644076.
2. Akıncı O, Abdulrahman SMFA, Güngör Ö. Mini-incision open appendectomy versus laparoscopic appendectomy: An experience in a rural hospital. Ulus Travma Acil Cerrahi Derg. 2021 May;27(3):310-314. doi: 10.14744/tjtes.2020.83023. PMID: 33884604.
3. Güler Y, Karabulut Z, Çaliş H, Şengül S. Comparison of laparoscopic and open appendectomy on wound infection and healing in complicated appendicitis. Int Wound J. 2020 Aug;17(4):957-965. doi: 10.1111/iwj.13347. PMID: 32266786; PMCID: PMC7948792.
4. Takami T, Yamaguchi T, Yoshitake H, Hatano K, Kataoka N, Tomita M, et al. A clinical comparison of laparoscopic versus open appendectomy for the treatment of complicated appendicitis: historical cohort study. Eur J Trauma Emerg Surg. 2020 Aug;46(4):847-851. doi: 10.1007/s00068-019-01086-5. PMID: 30710176; PMCID: PMC7429533.
5. Wang B, Shi L, Fu W, Liu T. Effects of sequence of irrigation, suction, and extraction in cases of acute purulent appendicitis or gangrenous perforated appendicitis after laparoscopic appendectomy. J Laparoendosc Adv Surg Tech A. 2021 Jul;31(7):751-755. doi: 10.1089/lap.2020.0610. PMID: 32960131.
6. Nepal YJ, Paudyal S, Shah S, Giri N. Laparoscopic appendectomy versus open appendectomy in acute appendicitis. J Nepal Health Res Counc. 2023 Jul;20(4):825-829. doi: 10.33314/jnhrc.v20i4.3681. PMID: 37489661.
7. Liu J, Wang Q. Impact of surgical site infection after open and laparoscopic surgery among paediatric appendicitis patients: A meta-analysis. Int Wound J. 2024 Apr;21(4):e14524. doi: 10.1111/iwj.14524. PMID: 38084057; PMCID: PMC10961035.
8. Li C, Liu Y, Jiang Y, Xu Y, Wang Z. Single-incision compared with conventional laparoscopy for appendectomy in acute appendicitis: a systematic review and meta-analysis. Int J Colorectal Dis. 2022 Sep;37(9):1925-1935. doi: 10.1007/s00384-022-04231-6. PMID: 35934748.
9. Katar MK, Başer M, Ersoy PE. Appendectomy in patients with morbid obesity: Laparoscopic versus conventional technique. Med Sci Monit. 2020 Dec 8;26:e928067. doi: 10.12659/MSM.928067. PMID: 33335087; PMCID: PMC7733308.
10. Liu F, Lv Q, Wang CY, Li ZW, Liu XR, Peng D. Single-port laparoscopic appendectomy using new surgical procedure versus conventional three-port laparoscopic appendectomy. Updates Surg. 2024 Aug;76(4):1347-1355. doi: 10.1007/s13304-024-01775-w. PMID: 38441852.
11. Jarupla SN, Vadthya G, Chowdhary MA, Tiwari HD, Pandey PR, Syed AK, et al. An evaluation of the choice of the treatment for the acute appendicitis an original research. J Pharm Bioall Sci 2022;14:S188-90.
12. Manek P, Patel M, Joshi S. Assessment of Discomfort and Analgesic Usage Following Pediatric Dental Procedures. Journal of Pharmacy and Bioallied Sciences. 2024;16(Suppl 2):S789–S794. doi: 10.4103/jpbs.jpbs_1095_23.
13. Manek P, Shah R, Gupta N. Detection and Management of ADRs in a Tertiary Hospital in India. AIJRRLSJM. 2023;6(2):123–130. doi: 10.22259/2639-6736.0602005.
14. Krishnappa M, Tiwari RVC, Tiwari HD, Syed AK, Mahajan A, Sharma K. Study of correlation between hand washing practice and gastroenteritis in rural students: An original research. J Adv Med Dent Sci Res. 2022;10(11):10–3.
15. Syed AK, Godavarthy DS, Kumar KK, Poosarla CS, Reddy GS, Reddy BV. Estimation of salivary superoxide dismutase, glutathione peroxidase, catalase in individuals with and without tobacco habits. J NTR Univ Health Sci. 2021;10(1):27–32.
16. Mandal NB, Kumari A, Yemineni BC, Airan M, Tiwari RV, Damarasingu R, et al. The prosthetic complications and the survival of the implant-fixed complete dental prostheses: An original study. J Pharm Bioallied Sci. 2022;14(Suppl 1):S301–3. doi:10.4103/jpbs.jpbs_773_21.
17. Aref S, Ravuri P, Kubavat AK, Sowmya C, Nallamilli LVS, Bhanawat N, et al. Comparative analysis of braces and aligners: Long-term orthodontic outcomes. J Pharm Bioallied Sci. 2024;16(Suppl 3):S2385–7. doi:10.4103/jpbs.jpbs_268_24.
18. Parmar D, Tiwari R, Antony JM, Dixit Tiwari H, Kalmee Syed A, Pandey PR. Exploring the impact, risk factors, and therapeutic approaches for COVID-19 related maxillofacial complications: A comprehensive analysis from a specialized healthcare center. J Adv Med Dent Sci Res. 2023;11(11):1–6.
19. Paul AG, Ali MMS, P AM, Das G, Syed AK, Tiwari R, et al. Prediction of seasonal allergic diseases in children using specific markers. J Cardiovasc Dis Res. 2024;:458–60.
20. Kaur GP, Goyal JD, Movva JB, Sanda S, Aravinth R, Syed AK, et al. Impact of rapid response teams on patient outcomes in emergency departments: A multicenter study. J Cardiovasc Dis Res. 2023;14(6):2952–8.