Is laparoscopic appendectomy better choice compared to open appendectomy

Objective: To compare laparoscopic appendectomy to open appendectomy for operation time, complications, hospital stay, time off work, cosmetic effects and diagnostic accuracy above the age of 12 years, to see if it was better choiceas compared to open appendectomy, the existing gold standard. Methodology: It is a prospective non-randomized controlled 3 years trial conducted at QAMC/BVH Bahawalpur, Pakistan from October 1, 2014 to September 30, 2017. It included 290 patients of acute appendicitis, 138 were operated laparoscopically and 152 by open appendectomy. Operation time, complications, hospital stay, time off work, cosmetic effects and diagnostic accuracy were compared in two groups. Data analysis was done on SPSS version 23. Results: Mean age of patients was 25.19+10.19 in laparoscopic group and 26.08+10.71 in open appendectomy group. Of 290, 45(29.60%) were obese in open appendectomy and 47(31.15%) were obese in laparoscopic group. Operation time was 29.03 +/- 8.33 minutes in open group and 39.10 +/- 8.82 minutes in laparoscopic group. Hospital stay was 3.13 +/- 1.42 days and 2.05 +/- 1.34 days in open appendectomy and laparoscopicgroup, respectively. Time off work was 12.09 +/- 3.68 and 8.70 +/- 3.83 days in open appendectomy and laparoscopic group. Overall per-operative complications were 0.65% to 2.17 %(P=0.276) and postoperative were 18.42 to 9.42%(P=0.02) in open and laparoscopic group, respectively. Most significant was wound infection 9.86% to 3.62% in open and laparoscopic group, respectively. In obese patients, there was significant difference in complications in open (9.86%) to laparoscopic (2.89%) groups. Conversion and re-exploration were 00 to 2.17% and 2.63% to 1.44% in open and laparoscopic groups, respectively. Diagnostic failure was 9.8% to 2.17% (P=0.005) in open and laparoscopic group. Patients were happy with scar in 72.46% in laparoscopic group and worried in 34.21% in open group. Conclusion: Laparoscopic appendectomy is better choiceabove the age of 12 years as compared to open appendectomy, even more feasible in obese patients.