Acute appendicitis is one of the most frequent causes of acute abdominal pain requiring surgical intervention worldwide. It affects approximately 7–10% of the population at some point in their lives, with peak incidence occurring between the second and third decades of life [1]. Since its first description by McBurney in 1894, open appendectomy (OA) remained the standard treatment for over a century. However, with the advent of minimally invasive surgical techniques, laparoscopic appendectomy (LA), first performed by Semm in 1983 [2], has emerged as a popular alternative.

Laparoscopic appendectomy involves removal of the appendix using small incisions, a laparoscope, and specialized instruments, which potentially offers several benefits over the conventional open method. These include less post-operative pain, reduced wound infection rates, shorter hospital stay, quicker return to daily activities, and better cosmetic results [3]. Despite these advantages, open appendectomy continues to be practiced widely, particularly in developing countries, due to its technical simplicity, lower costs, and widespread familiarity among general surgeons.

There is ongoing debate among surgeons regarding the superiority of LA over OA, especially in resource-limited settings where factors such as cost, availability of equipment, and surgeon expertise play a pivotal role. Several studies and meta-analyses have compared the two approaches with mixed findings. Some report significantly better outcomes with LA [4], while others suggest the benefits may not be clinically significant, particularly when complications such as perforation, abscess, or dense adhesions are present [5].

In India, the choice between laparoscopic and open techniques often depends on institutional protocols, surgeon preferences, and patient affordability. Given this context, it is important to assess and document local experiences regarding the safety, efficacy, and outcomes of these surgical approaches.

This study was undertaken in the Department of Surgery at a tertiary care hospital in Uttar Pradesh with the objective of comparing post-operative recovery parameters—including duration of hospital stay, pain scores, and time to return to normal activity—as well as the incidence of post-operative complications such as wound infections, in patients undergoing laparoscopic versus open appendectomy for acute uncomplicated appendicitis.

This prospective, observational comparative study was conducted in the Department of Surgery at MV ASMC Ghazipur in Uttar Pradesh over a period of 12 months, from January 2024 to December 2024. The study included patients presenting with clinical signs and symptoms suggestive of acute uncomplicated appendicitis. Diagnosis was based on clinical evaluation supported by laboratory investigations and ultrasonography. Eligible patients were between 15 and 60 years of age and provided informed written consent for participation in the study. Patients with complicated appendicitis (perforation, abscess, or gangrene), those with significant comorbidities (e.g., uncontrolled diabetes mellitus, immunocompromised states), pregnant women, and patients with a history of prior abdominal surgeries were excluded from the study.

A total of 120 patients who met the inclusion criteria were enrolled and were divided into two groups based on the surgical technique employed: Group A underwent laparoscopic appendectomy (LA), and Group B underwent open appendectomy (OA), with 60 patients in each group. The choice of procedure was determined by surgeon preference, availability of laparoscopic equipment, and patient suitability. All surgeries were performed by experienced surgeons with comparable proficiency in both laparoscopic and open techniques.

Data were collected on demographic parameters (age, sex), intraoperative findings, duration of surgery, and post-operative outcomes. Post-operative pain was assessed using the Visual Analogue Scale (VAS) at 12 and 24 hours after surgery. Other parameters included duration of hospital stay (in days), time to resume routine activities (in days), and the occurrence of post-operative complications such as surgical site infection, ileus, and intra-abdominal abscess. Patients were followed up for two weeks post-surgery.

Data analysis was performed using SPSS version 25.0. Continuous variables such as operative time, pain score, and hospital stay were expressed as mean ± standard deviation and compared between the groups using the independent t-test. Categorical variables, such as gender distribution and incidence of complications, were analyzed using the Chi-square test. A p-value of less than 0.05 was considered statistically significant.

A total of 120 patients were included in the study, with 60 patients undergoing laparoscopic appendectomy (LA group) and 60 patients undergoing open appendectomy (OA group). The groups were comparable in terms of age and gender distribution.

Table 1: Baseline Demographic Profile

There was no statistically significant difference in the age or gender distribution between the two groups (p > 0.05), indicating proper comparability for analysis.

Table 2: Intraoperative Findings and Operative Time

The mean operative time was slightly longer in the LA group, and the difference was statistically significant (p = 0.02).

Table 3: Post-Operative Pain (VAS Score)

VAS pain scores at both 12 and 24 hours were significantly lower in the laparoscopic group compared to the open group (p < 0.001), indicating better post-operative comfort.

Table 4: Recovery Parameters

Patients in the LA group had a significantly shorter hospital stay and resumed normal activities earlier than those in the OA group.

Table 5: Post-Operative Complications

The incidence of surgical site infection was significantly higher in the OA group (p = 0.01), while other complications did not differ significantly between the groups.

The findings of this study clearly demonstrate that laparoscopic appendectomy (LA) offers significant advantages over open appendectomy (OA) in terms of post-operative recovery and complications. Although the operative time was slightly longer for LA, patients experienced significantly reduced post-operative pain, shorter hospital stays, faster return to normal activities, and a lower incidence of surgical site infections. These results align with global trends favoring minimally invasive approaches for common surgical conditions like acute appendicitis.

The slightly longer operative time in the laparoscopic group (58.4 ± 11.3 minutes vs. 52.1 ± 9.2 minutes) can be attributed to the technical demands of laparoscopy, including trocar placement, creation of pneumoperitoneum, and intracorporeal dissection and suturing. However, this difference was modest and statistically significant (p = 0.02), and likely reflects the learning curve associated with laparoscopic procedures. As shown in prior studies, operative times tend to decrease with increasing surgical experience and improved instrumentation [1,2].

One of the most notable advantages observed in the LA group was the reduction in post-operative pain, as assessed by VAS scores at 12 and 24 hours. The minimally invasive nature of laparoscopic surgery, with smaller incisions and less tissue trauma, contributes to lower pain perception. This finding is consistent with earlier research by Guller et al. [3], who reported significantly reduced analgesic requirements in laparoscopic appendectomy patients.

Hospital stay was also significantly reduced in the LA group (2.4 vs. 4.1 days), which reflects quicker recovery and fewer complications. Early mobilization and resumption of oral intake are hallmarks of laparoscopic recovery protocols and contribute to this shortened stay. This outcome supports the results of a meta-analysis by Jaschinski et al. [4], which concluded that LA patients have a mean hospital stay 1.1 days shorter than those undergoing OA. From a hospital resource-utilization standpoint, this reduction in hospital stay translates to improved bed turnover and cost efficiency, especially in high-volume centers.

Return to routine activities is a major concern for working individuals and students. In this study, patients who underwent LA returned to their normal activities significantly earlier than those in the OA group (7.2 vs. 11.5 days, p<0.001). This advantage is clinically significant in terms of reducing the indirect costs of illness, such as loss of income and productivity. Similar outcomes were reported by Bhangu et al. [5] in their global audit of appendectomy outcomes.

In terms of post-operative complications, the LA group demonstrated a lower rate of surgical site infections (6.7%) compared to the OA group (21.7%), which was statistically significant (p = 0.01). This reduction can be attributed to the use of smaller incisions and less handling of bowel and soft tissue in LA. Additionally, the peritoneal cavity is less exposed to external contaminants in laparoscopy, thus reducing the risk of infection. Prior Indian studies, such as those by Khan et al. [6], also reported lower infection rates in laparoscopic appendectomy, reinforcing our findings.

Other complications such as post-operative ileus and intra-abdominal abscesses were rare and did not show statistically significant differences between the groups. Importantly, no mortality was recorded in either group, and all patients recovered uneventfully with routine post-operative care.

While LA offers distinct benefits, its application must be balanced against institutional factors such as the availability of laparoscopic equipment, surgeon expertise, and patient affordability. In resource-constrained settings, the initial capital investment and operative costs may limit the routine use of LA. However, considering the improved outcomes, patient satisfaction, and faster return to function, LA should be promoted and adopted where feasible.

It is also important to recognize certain limitations of this study. It was a single-center study with a relatively modest sample size, and only uncomplicated cases of acute appendicitis were included. Hence, the findings may not be generalizable to all patient subgroups, such as those with perforated appendicitis, abscess, or generalized peritonitis. Future studies with larger sample sizes and multicenter designs are recommended to validate these findings and explore cost-effectiveness aspects in the Indian healthcare setting.

Key Findings in Context of Existing Literature

PARAMETER       OUR STUDY        LITERATURE SUPPORT

OPERATIVE TIME              LA longer than OA            Similar findings by Shakya et al. [7]

PAIN SCORE        Lower in LA         Supported by Guller et al. [3]

HOSPITAL STAY  Shorter in LA       Confirmed by Jaschinski et al. [4]

RETURN TO WORK           Faster in LA         Supported by Bhangu et al. [5]

WOUND INFECTION       Lower in LA         Similar to Khan et al. [6]

In conclusion, laparoscopic appendectomy significantly outperforms open appendectomy in terms of post-operative pain, hospital stay, recovery time, and wound-related complications. While LA requires appropriate infrastructure and surgical training, its adoption should be encouraged, especially in tertiary care settings. With ongoing technological advancements and increasing laparoscopic proficiency among surgeons, LA is likely to become the standard of care for uncomplicated appendicitis in India.

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