Clinical-Operative Outcomes of Laparoscopic Versus Open Appendicectomy in Adults with Complicated and Uncomplicated Acute Appendicitis: A Cross-Sectional Observational Study at a Tertiary Care Hospital

Abstract

Background: The laparoscopic appendicectomy (LA) is the preferred method of dealing with uncomplicated acute appendicitis in high-income nations, whereas a comparison of its outcomes with surgical appendicectomy (SA) is scarce in the Indian tertiary care setting, especially with the complicated appendicitis. Real World Outcomes inform institutional surgical practice and training.

Methods: Two groups were compared: LA (n=140) and OA (n=80) in 220 adults in a cross sectional observational study over 18 months in a tertiary care hospital. Operative parameters, total cost, length of stay, complication status (perforated/gangrenous/abscess), AIR score, and Alvarado score were documented. Results: Mean operative time was longer in LA (64.2±18.4 vs 46.8±14.2 minutes, p<0.001). SSI was significantly lower in LA (4.3% vs 16.3%, p=0.004). Postoperative ileus (3.6% vs 11.3%, p=0.034), mean LOS (2.8 vs 5.2 days, p<0.001), and opioid requirement were also significantly lower in LA. Multivariable predictors of SSI: open approach (aOR 3.6), complicated appendicitis (aOR 2.9), diabetes (aOR 1.9), and delayed presentation >48 hours (aOR 1.7). Conclusion: Laparoscopic appendicectomy is associated with significantly lower SSI, shorter LOS, and reduced ileus compared to open approach, including in complicated appendicitis. Expansion of LA capability and training at tertiary care hospitals is recommended.