Comparative Evaluation of Laparoscopic Versus Open Appendectomy in Adult Patients with Acute Appendicitis: A Prospective Comparative Study of Surgical Outcomes and Recovery.

Abstract

Background: Acute appendicitis remains one of the most common surgical emergencies encountered in general surgical practice worldwide, with a lifetime prevalence of approximately 7–8%. Although laparoscopic appendectomy (LA) has progressively gained acceptance since its introduction, the debate regarding its superiority over conventional open appendectomy (OA), particularly in resource-limited settings, continues, with mixed evidence regarding operative time, cost, and post-operative recovery. Objectives: To prospectively compare the intraoperative parameters, post-operative pain, recovery indices, morbidity, and short-term outcomes of laparoscopic versus open appendectomy in adult patients with acute appendicitis at a tertiary care teaching hospital. Materials and Methods: A hospital-based prospective comparative study was conducted in the Department of General Surgery, Sapthagiri Institute of Medical Sciences and Research Centre (SIMSRC), Chikkabanavara, Bengaluru – 560090, Karnataka, India, from 22 February 2026 to 22 May 2026. A total of 46 adult patients (aged ≥18 years) with a clinical and radiological diagnosis of acute appendicitis were allocated by simple randomization into two equal groups of 23 patients each: Group A (laparoscopic appendectomy) and Group B (open appendectomy). Outcome parameters recorded included operative time, intraoperative blood loss, post-operative pain (Visual Analogue Scale), time to oral intake, time to ambulation, length of hospital stay, complications, return to work, cosmetic satisfaction, and hospitalization cost. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 22.0; a p-value < 0.05 was considered statistically significant. Results: The two groups were comparable in age, gender, body mass index, and Alvarado score at presentation (p > 0.05). Mean operative time was significantly longer in Group A (62.5 ± 12.4 minutes) than in Group B (48.3 ± 10.7 minutes; p < 0.001), whereas mean intraoperative blood loss was significantly less in Group A (18.6 ± 6.2 mL vs 42.5 ± 13.8 mL; p < 0.001). Post-operative VAS pain scores were consistently lower in Group A at 6, 24, 48, and 72 hours (p < 0.001). Mean length of hospital stay (3.1 ± 0.8 vs 5.2 ± 1.4 days; p < 0.001) and mean time to return to work (12.4 ± 3.2 vs 21.6 ± 5.7 days; p < 0.001) were both significantly shorter following LA. The overall post-operative complication rate was 17.4% in Group A compared with 34.8% in Group B, largely driven by a lower incidence of surgical site infection in the LA group (8.7% vs 26.1%). Cosmetic satisfaction at three months was significantly higher after LA (8.6 ± 0.9 vs 6.2 ± 1.3; p < 0.001), although the total hospitalization cost was higher (₹32,500 ± ₹4,200 vs ₹22,800 ± ₹3,500; p < 0.001). Conclusion: Laparoscopic appendectomy offers demonstrable advantages over open appendectomy in adults with acute appendicitis, including less post-operative pain, faster recovery, shorter hospital stay, earlier return to work, fewer wound-related complications, and superior cosmetic outcomes, despite a longer operative time and higher immediate cost. Wider adoption of the laparoscopic technique is recommended wherever expertise and infrastructure permit, and cost-offsetting through shorter hospitalization and earlier return to productivity should be considered when comparing the two approaches.