World Journal of Laparoscopic Surgery

Register      Login

VOLUME 14 , ISSUE 1 ( January-April, 2021 ) > List of Articles

Original Article

Laparoscopic or Open Appendectomy: Which Approach is the Best for Complicated Appendicitis?

Ruhi F Jailani, Norjazliney A Jafri, Gerald Henry, Ismail Sagap

Citation Information : Jailani RF, Jafri NA, Henry G, Sagap I. Laparoscopic or Open Appendectomy: Which Approach is the Best for Complicated Appendicitis?. World J Lap Surg 2021; 14 (1):1-4.

DOI: 10.5005/jp-journals-10033-1430

License: CC BY-NC 4.0

Published Online: 01-04-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Introduction: Appendicitis is more common in children and young adults. Treatment of appendicitis is either laparoscopic appendicectomy (LA) or open appendicectomy (OA) surgery. Aim and objective: The 30-day postoperative morbidity, surgical site infection, and reoperation rate were compared between open and laparoscopic appendicectomies for complicated appendicitis. Secondary outcome measures were the length of hospital stay, duration of surgery, surgical waiting time, identification of other diseases, and patient satisfaction. Materials and methods: This retrospective study was conducted in two institutions: Hospital Selayang, Selangor, Malaysia, and HUKM, Kuala Lumpur, Malaysia. Data were collected from January 2014 to December 2015 were reviewed. Results: The mean age (±SD) for LA and OA were 32 (±15) and 30 (±14) years, respectively. The males showed predominance in LA and OA with 52 and 72%, respectively (p < 0.001). The majority of LA (73%) and OA (88%) were performed by the trainees (p < 0.001). There was a significant reduction in postoperative morbidity in LA compared to OA in terms of surgical site infection, LA vs OA [n = 8 (2.7) vs 26 (6.3), p = 0.029] and duration of surgery [LA vs OA 84 (±39) vs 68 (± 6) days (p < 0.001)]. However, for LA and OA, there were no significant differences in reoperation, 0.7 and 1.0%, respectively (p = 1.000), and length of stay in LA vs OA 3.55 (±2) vs 3.89 (±3) days, respectively (p = 0.103). Overall, patient satisfaction scores were not found statistically significant as the response rates were only 32% in LA and 30% in OA. Conclusion: LA significantly reduced surgical site infection and offered an advantage in the detection of other pathologies. Hence, a laparoscopic approach should be offered to patients whose clinical diagnoses are challenging.

  1. Ghnnam WM. Elderly versus young patients with appendicitis 3 years experience. Alexandria J Med 2012;48(1):9–12. DOI: 10.1016/j.ajme.2011.10.004.
  2. Sauerland S, Jaschinski T, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 2010;(10):CD001546. DOI: 10.1002/14651858.CD001546.pub3.
  3. Park HC, Kim BS, Lee BH. Laparoscopic treatment of presumed perforated appendicitis in consecutive patients. Surg Laparosc Endosc Percutan Tech 2011;21(4):278–281. DOI: 10.1097/SLE.0b013e318221bb23.
  4. Vahdad MR, Troebs RB, Nisen M, et al. Laparoscopic appendectomy for perforated appendicitis in children has complication rates comparable with those of open appendicectomy. J Pediatric Surg 2013;48(3):555–561. DOI: 10.1016/j.jpedsurg.2012.07.066.
  5. Markides G, Subar D, Riyad K. Laparoscopic versus open appendectomy in adults with complicated appendicitis: systematic review and meta-analysis. World J Surg 2010;34(9):2026–2040. DOI: 10.1007/s00268-010-0669-z.
  6. Yau KK, Siu WT, Tang CN, et al. Laparoscopic versus open appendectomy for complicated appendicitis. J Am Coll Surg 2007,205(1):60–65. DOI: 10.1016/j.jamcollsurg.2007.03.017.
  7. Gürleyik G, Gürleyik E. Age-related clinical features in older patients with acute appendicitis. Eur J Emerg Med 2003;10(3):200–203. DOI: 10.1097/01.mej.0000088431.19737.f8.
  8. Kokoska ER, Silen ML, Tracy TF, et al. Perforated appendicitis in children: risk factors for the development of complications. Surgery 1998;124(4):619–626. DOI: 10.1067/msy.1998.91484.
  9. Kang KJ, Lim TJ, Kim YS. Laparoscopic appendectomy is feasible for the complicated appendicitis. Surg Laparosc Endosc Percutan Tech 2000;10(6):364–367.
  10. Aziz O, Athanasiou T, Tekkis PP, et al. Laparoscopic versus open appendectomy in children: a meta-analysis. Ann Surg 2006;243(1):17–27. DOI: 10.1097/01.sla.0000193602.74417.14.
  11. Tiwari MM, Reynoso JF, Tsang AW, et al. Comparison of outcome of laparoscopic and open appendectomy in management of complicated and uncomplicated appendicitis. Ann Surg 2011;254(6):927–932. DOI: 10.1097/SLA.0b013e31822aa8ea.
  12. Southgate E, Vousden N, Karthikesalingam A, et al. Laparoscopic vs open appendectomy in older patients: a meta-analysis (review). Arch Surg 2012;147(6):557–562. DOI: 10.1001/archsurg.2012.568.
  13. Hornby ST, Shahtahmassebi G, Lynch S, et al. Delay to surgery does not influence the pathological outcome of acute appendicitis. Scand J Surg 2013;103(1):5–11. DOI: 10.1177/1457496913495474.
  14. Casarotto A, Zarantonello FR, Rebonato M. Appendectomy in women. Is the laparoscopic approach always better than the “open” approach in uncomplicated appendicitis? Surg Laparosc Endosc Percutan Tech 2014;24(5):406–409. DOI: 10.1097/SLE.0000000000000063.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.