Evaluation of the laparoscopic versus the open approach in patients with complicated appendicitis

Abstract

Context Open appendectomy is the standard procedure for complicated appendicitis and is associated with an increased incidence of postoperative complications. Recently, laparoscopic approach for complicated appendicitis has been gaining ground against the open approach. Some studies still favor the open approach while others advocate the laparoscopic approach. Aim The present study aimed to compare the laparoscopic approach with the open approach in the management of patients with complicated appendicitis, and their postoperative complications. Settings and design This was a prospective, randomized, comparative study. Patients and methods Eighty-eight patients were included in the study and were divided into the laparoscopic group (33 patients) and the open group (55 patients). Each group was further divided into five subgroups according to the operative findings. All patients were monitored for early and late postoperative complications and followed up in the outpatient clinic for 6 months. The operative time, rate of conversion, drain application, early and late complications, frequency of analgesia, time to start oral feeding, length of hospital stay, and time of returning to normal daily activity were all recorded. Statistical analysis Continuous variables were expressed as mean and SD. Categorical variables were expressed as frequencies and percentage. Results The open group showed less operative time. Patients in the laparoscopic group needed less analgesia, with early return of the bowel habits and early start of oral feeding. They also had shorter hospital stay and early return to the normal activities. The laparoscopic group had less postoperative complication in comparison with the open group. Conclusion The laparoscopic appendectomy was found to be better in comparison with the open approach as it involved less postoperative pain, shorter hospital stay, and fewer postoperative complications in addition to the possibility of exploring the whole abdomen.