A Prospective and Comparative Study of Laparoscopic Appendectomy and Open Appendectomy in the Surgical Treatment of Appendicitis.

Introduction Appendicitis is a prevalent surgical etiology of abdominal pain encountered in medical emergencies globally. Consequently, appendectomy is the most commonly performed surgical procedure. Despite advancements in surgical techniques, there is a lack of prospective studies evaluating these approaches across the full spectrum of appendicitis severity. Due to the absence of consensus on the optimal approach, both open and laparoscopic appendectomy are frequently being practiced. Our study aims to address this gap by providing a comprehensive comparison of laparoscopic and open appendectomy performed in all diagnosed uncomplicated and complicated cases of appendicitis, which includes acute appendicitis, sub-acute appendicitis, chronic appendicitis, appendicular perforation, appendicular abscess. Materials and methods This was a prospective study, performed at the Department of General Surgery, Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College, Kanpur, between September 2023 and August 2024. The 60 patients were divided, using the odd-even method, between the laparoscopic appendectomy group (LA) and the open appendectomy group (OA), with 30 patients in each group. The study included patients with uncomplicated as well as complicated appendicitis and was conducted after attaining informed consent and ethical approval for the study. Results The laparoscopic approach offered a significantly shorter duration of hospital stay (3.57±2.5 days in LA and 7.53±2.7 days in OA), better postoperative pain recovery (mean VAS score being 2.17±1.13 in LA and 4.30±0.64 in OA) and reduced need for either oral or intravenous analgesics, 24 hours postoperatively, earlier return of normal bowel activity (8.2±4.2 hours in LA and 15.6±5.9 hours in OA), oral intake tolerance (96.7% patients in LA and 76.7% patients in OA were able to tolerate oral liquids on the first postoperative day), earlier return to routine activities (4.17±3.8 days and 7.17±2.7 days in LA and OA, respectively) and higher patient satisfaction (90% patients after LA and 60% patients after OA were "extremely satisfied"). The only shortcoming was the increased duration of surgery (53.17±12.4 and 23.7±6.2 min in the LA and OA groups, respectively). While few complications were more commonly associated with either procedure, like intra-abdominal abscess (6.7%) with LA and wound infection (10%) with OA, no statistically significant difference was observed in overall postoperative complication rates among the two groups. The quality of recovery after either procedure did not have a significant difference on long-term follow-up after surgery. Conclusion Our study revealed that the laparoscopic appendectomy group offered several significant advantages in postoperative recovery over the open appendectomy group, both in uncomplicated as well as complicated cases of appendicitis. Thus, laparoscopic appendicectomy should be considered as the surgery of choice, in uncomplicated as well as complicated cases of appendicitis, given that surgical skills are available.