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A comparative study of laparoscopic appendectomy versus open appendectomy for the treatment of acute appendicitis
Original Research
A comparative study of laparoscopic appendectomy versus open
appendectomy for the treatment of acute appendicitis
Dr. Anil Haripriya



1Associate professor, Department of General Surgery CIMS, Bilaspur (C.G.), India;
2Associate Professor, Department of General Surgery, NSCB Medical College, Jabalpur (M.P.), India
ABSTRACT:
Background: The present study was conducted to compare open versus laparoscopic appendectomy in acute appendicitis.
Materials & Methods: 68 cases of acute appendicitis were divided into 2 groups. Group I patients were subjected to laparoscopy
appendectomy and Group II patients subjected to open appendectomy. Results: Symptoms were nausea/vomiting seen 28 in
group I and 26 in group II, abdominal pain 32 in group I and 33 in group II and fever in 25 in group I and 21 in group II. The
difference was non- significant (P> 0.05). Oral feed started postoperatively at mean of 5.9 days in group I and 2.6 days in group
II, average hospital stay was 5.6 days in group I and 4.2 days in group II. Wound abscess was seen in 3 days in group I and 4
days in group II and wound infection 2 days in group I and 8 days in group II. The difference was significant (P< 0.05).
Conclusion: Laparoscopic appendectomy is effective method of acute appendicitis as compared to open appendectomy.
Key words: Acute appendicitis, Laparoscopic appendectomy, Oral feed
Received: 11 September, 2020 Accepted: 16 November, 2020
Correspondence: Dr. Arvind Baghel, Associate Professor, Department of General Surgery, NSCB Medical College, Jabalpur
(M.P.), India
This article may be cited as: Haripriya A, Baghel A. A comparative study of laparoscopic appendectomy versus open
appendectomy for the treatment of acute appendicitis. J Adv Med Dent Scie Res 2020;8(12):42-45.
INTRODUCTION
Acute appendicitis is the most common emergent
abdominal condition requiring surgical intervention.
Appendicitis is inflammation of the appendix.
1
Symptoms commonly include right lower abdominal
pain, nausea, vomiting, and decreased appetite.
However, approximately 40% of people do not have
these typical symptoms. Severe complications of a
ruptured appendix include widespread, painful
inflammation of the inner lining of the abdominal wall
and sepsis.
2
Appendicitis is the most common cause of the acute
abdomen in the United States, with an estimated
lifetime risk between 5 and 20%. In fact, appendectomy
is the most common non-elective operation performed
by general surgeons. Although it has been over 115
years since Reginald Heber Fitz first demonstrated the

natural history and pathophysiology of appendicitis and
advocated early appendectomy in his landmark article,
appendicitis continues to present challenges for the
surgeon today.3
Appendectomy is the most commonly performed
operation in the world, 6% of all the surgical procedures
and is done as emergency procedure wherever possible,
the only exception is formation of appendicular mass or
abscess. In these cases, interval appendectomy is
performed as elective procedure.4
Laparoscopic appendectomy gives a better evaluation of
the peritoneal cavity than that obtained by open
approach and also facilitates other differential
diagnosis. Advantages of laparoscopic approach include
less operative time, less postoperative pain, reduced
analgesia, less surgery associated complications, shorter
hospital stay, faster recovery, reduced wound infection

Journal of Advanced Medical and Dental Sciences Research
@Society of Scientific Research and Studies NLM ID: 101716117
Journal home page: www.jamdsr.com doi: 10.21276/jamdsr Index Copernicus value = 85.10

(e) ISSN Online: 2321-9599; (p) ISSN Print: 2348-6805

Haripriya A et al. Laparoscopic appendectomy versus open appendectomy.

43

Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 12| December 2020
and minimal scarring.5 The present study was
conducted to compare open versus laparoscopic
appendectomy in acute appendicitis.
MATERIALS & METHODS
The present study was conducted in the department of
general surgery in a medical college hospital. It
comprised of 68 cases of acute appendicitis. Patients
were informed regarding the study and written consent
was taken.

Patient information such as name, age, gender etc. was
recorded. Patients were diagnosed on the basis of
physical examination, laboratory tests and ultrasound
examination (USG). Patients were divided into 2
groups. Group I patients were subjected to laparoscopy
appendectomy and Group II patients subjected to open
appendectomy. Patients were monitored for pulse rate,
blood pressure, temperature, respiratory rate, bowel
sounds and urinary output. Patients were put on follow
up at 1 week, 2 weeks and 4 weeks after surgery. P
value less than 0.05 was considered significant.

RESULTS
Table I Distribution of patients

Groups Group I Group II
Number Laparoscopy appendectomy Open appendectomy
Number 34 34

Table I shows that group I patients were subjected to laparoscopy appendectomy and group II patients subjected to
open appendectomy.
Table II Assessment of symptoms

Symptoms Group I Group II P value
Nausea/vomiting 28 26 0.97
Abdominal pain 32 33 0.94
Fever 25 21 0.91

Table II shows that symptoms were nausea/vomiting seen 28 in group I and 26 in group II, abdominal pain 32 in
group I and 33 in group II and fever in 25 in group I and 21 in group II. The difference was non- significant (P>
0.05).
Table III Assessment of parameters

Parameters Group I Group II P value
Oral feed started postoperatively 5.9 2.6 0.01
Average hospital stay 5.6 4.2 0.05
Wound abscess 3 4 0.05
Wound infection 2 8 0.01

Table III, graph I shows that oral feed started postoperatively at mean of 5.9 days in group I and 2.6 days in group II,
average hospital stay was 5.6 days in group I and 4.2 days in group II. Wound abscess was seen in 3 days in group I
and 4 days in group II and wound infection 2 days in group I and 8 days in group II. The difference was significant
(P< 0.05).
Graph I Assessment of parameters

0
1
2
3
4
5
6
7
8

Oral feed started
postoperatively

Average hospital
stay

Wound abscess Wound infection

5.9 5.6

3

2

2.6

4.2 4

8

Group I
Group II

Haripriya A et al. Laparoscopic appendectomy versus open appendectomy.

44

Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 12| December 2020
DISCUSSION
The diagnosis of acute appendicitis is often difficult,
and challenging. The most common cause of surgical
abdomen is appendicitis affecting all the age groups.6
The maximum incidence is documented to be about 7-
10 % of the general population in the second and third
decades of life.7 Appendectomy is the operation which
is most commonly performed by the general surgeons.
The Laparoscopic appendectomy was first performed
by Semm K, German Gynaecologist.8

It has gained
acceptance with the technological advances of the past
two to three decades as a diagnostic and treatment
method for acute appendicitis. From that time, this
procedure has been used widely. In spite of its wide
acceptance, there remains a continuing debate in the
literature related to the most appropriate way of
removing the inflamed appendix.9 The present study
was conducted to compare open versus laparoscopic
appendectomy in acute appendicitis.
In present study, group I patients were subjected to
laparoscopy appendectomy and group II patients
subjected to open appendectomy. Burra et al10 in their
study a total 140 patients admitted with clinical
diagnosis of acute or recurrent appendicitis. They were
divided into two groups: open appendectomy (OA)
group with 70 patients in each) and laparoscopic
appendectomy (LA) group (70 patients in each). OA
was performed through standard Mc Burney incision. A
standard 3-port technique was used in this study for the
laparoscopic procedure. It is found that laparoscopic
appendectomy is as safe and effective as the open
procedure. The pain score was reduced in laparoscopic
which is 3.4±1.8 and in open 4.2±1.4. This difference
was found to be statistically significant at p value of
0.05. The duration of analgesics was also reduced in
laparoscopic with mean value of 4.81±3.6 and
10.32±4.2 and this difference was found to be
statistically significant at p value of 0.05.
We found that symptoms were nausea/vomiting seen 28
in group I and 26 in group II, abdominal pain 32 in
group I and 33 in group II and fever in 25 in group I and
21 in group II. Gupta et al11 compared and evaluated the
open and laparoscopic method of appendectomy in
acute appendicitis. The subjects undergoing
appendectomy were evaluated for age, sex, episode
number, duration of pain before presentation in
hospital, operative time, conversion rate, wound
infection, post-operative intra-abdominal abscess
formation, and stay in hospital. It was found that
average operative time in open surgery was 67.5
minutes and 104 minutes in laparoscopic surgery, with
a conversion to open in about 20% of the cases. Oral
feeding in the open group was around the 5th day while
it was around 2nd day in the laparoscopic group.
Average hospital stay was also low in the laparoscopic
group, being only around 5 days in laparoscopic group

and around 8 days in the open group. Overall
complications were also low in the laparoscopic surgery
group.
We observed that oral feed started postoperatively at
mean of 5.9 days in group I and 2.6 days in group II,
average hospital stay was 5.6 days in group I and 4.2
days in group II. Wound abscess was seen in 3 days in
group I and 4 days in group II and wound infection 2
days in group I and 8 days in group II.
Another study by Garg CP12 which studied a total of
110 patients, 61 of whom underwent open
appendectomy and the rest 49 underwent laparoscopic
appendectomy. Operative time was noted to be higher
in laparoscopic surgery, also it was noted that
laparoscopic surgery was associated with less analgesic
use, shorter hospital stay.
The shortcoming of the study is small sample size.
CONCLUSION
Authors found that laparoscopic appendectomy is safer
and effective method for patients of acute appendicitis
as compared to open appendectomy.
REFERENCES
1. Chiarugi M, Buccianti P, Celona G, Decanini L,
Martino MC, Goletti O et al. Laparoscopic compared
with open appendectomy for acute appendicitis: A
prospective study. Eur J Surg 1996; 162(2): 385–390.
2. Garbutt JM, Soper NJ, Shannon W, Botero A,
Littenberg B. Meta-analysis of randomized controlled
trials comparing laparoscopic and open appendectomy.
Surg Laparosc Endosc. 1999; 9(4):17-26.
3. Akshatha Manjunath, Aparajita Mookherjee.
Laparoscopic versus open appendectomy: An analysis
of the surgical outcomes and cost efficiency in a tertiary
care medical college hospital. International Journal of
Contemporary Medical Research 2016; 3(6):1696-
1700.
4. Di Saverio S. Emergency laparoscopy: a new emerging
discipline for treating abdominal emergencies
attempting to minimize costs and invasiveness and
maximize outcomes and patients’ comfort. J Trauma
Acute Care Surg. 2014; 77(1):338–50.
5. Hansen JB, Smithers MB, Schache D, Wall DR, Miller
BJ, Menzies BL. Laparoscopic versus open
appendectomy: prospective randomized trial. World J
Surg 1996; 20(5): 17–21.
6. Klingler A, Henle KP, Beller S, Rechner J, Zerz A,
Wetscher GJ. Laparoscopic appendectomy does not
change the incidence of postoperative infectious
complications. Am J Surg 175(3): 232–35.
7. Kurtz RJ, Heimann TM. Comparison of open and
laparoscopic treatment of acute appendicitis. Am J Surg.
2001; 182(6):211–4.
8. Chung RS, Rowland DY, Li P, Diaz J. A metaanalysis
of randomized controlled trials of laparoscopic versus
conventional appendectomy. Am J Surg. 1999;
177(1):250–6.

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Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 12| December 2020
9. Hellberg A, Rudberg C, Kullmann E, et al. Prospective
randomized multicentre study of laparoscopic versus
open appendectomy. Br J Surg. 1999; 86(4):48–53.
10. Burra Viswa Chaitanya, Rama Chandra Mohan
Mallapragada. Comparative evaluation of laparoscopic
with open appendectomy among patients of
appendectomy - A prospective study. International
Journal of Contemporary Medicine Surgery and
Radiology. 2019;4(3):C18-C22.
11. Gupta A, Singh AP. Comparative Evaluation of Open
and Laproscopic Method of Appendectomy in Acute
Appendicitis. Journal: Academia Journal of Surgery.
2020(1):8-11.
12. Garg CP, Vaidya BB, Chengalath MM. Efficacy of
laparoscopyin complicated appendicitis. Int J Surg.


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