Assessment of the Outcomes of Laparoscopic Versus Open Appendectomy: A Cross-sectional Study

Abstract

Introduction: We conducted a cross-sectional study in two institutions for reviewing the postoperative complications of laparoscopic appendectomy vs open appendectomy for complicated appendicitis. The primary objectives were detection of surgical site infection and reoperation within 30 days postoperatively. The secondary objectives were reducing the length of hospital stay, increasing patient satisfaction level, and identifying other diseases and postoperative complications like pneumonia, deep vein thrombosis, bedsores, and enterocutaneous fistulas. Materials and Methods: We analyzed 683 patients that met the inclusion criteria and their clin- ical data and hospital costs. The patients were divided into two groups: open appendectomy (OA) group and laparo- scopic appendectomy (LA) group. The collected clinical data included demographic data, co-morbidities, initial laboratory findings, operation time, intraoperative findings (acute, gangrenous or perforated appendix), time to soft diet, postoperative hospital stay, amount of analgesics and postoperative complications. Results: The laparoscopic group required fewer doses of paren- teral and oral analgesics in the operative and post- operative periods compared with the open appendectomy (P <0.0001). Bowel movements in the first postoperative day were observed in 93.5% patients subjected to laparoscopic appendectomy and 68.1% in the open group (P <0.001). As a result, 86.8% patients in the laparoscopic group and 61.1% in the open group were able to toler- ate a liquid diet within the first 24 postoperative hours (P <0.001). Conclusion: Our results showed the advantages of the laparoscopic approach over open appendectomy including shorter hospital stay, decreased need for postoperative analgesia, early food tolerance, earlier return to work, lower rate of wound infection, against only marginally higher hospital costs. Furthermore we found a considerable preference (during the collection of consent) of patients and a high satisfaction after the surgery in the laparoscopic group.