Comparative Evaluation of Laparoscopic Versus Open Surgical Management of Complicated Acute Appendicitis: Postoperative Morbidity, Recovery and Long-Term Outcome

Abstract

Background: Complicated acute appendicitis is associated with increased postoperative morbidity, prolonged hospitalization, and delayed recovery.

Objective: To compare the laparoscopic and open appendectomy in patients with complicated acute appendicitis.

Methodology: This comparative observational study was conducted at Department of General Surgery, Khairpur Medical College, Khairpur Mir’s from 1^st April 2025 to 30^th September 2025 included 282 patients with complicated acute appendicitis. Out of these, 146 underwent laparoscopic appendectomy and 136 underwent open appendectomy. Baseline characteristics, operative findings, postoperative complications, recovery parameters, readmission and long-term outcomes were compared.

Results: Baseline demographic and disease characteristics were comparable between the groups. Operative time was longer with laparoscopic appendectomy than with open appendectomy (76.5±18.7 vs. 69.4±17.1 minutes, p=0.001), whereas estimated blood loss (42.3±18.6 vs. 71.8±29.5 mL, p<0.001) and hospital stay (4.8±1.9 vs. 7.2±2.8 days, p<0.001) were lower. Laparoscopic appendectomy was associated with lower rates of surgical-site infection (8.2% vs. 19.1%, p=0.009), postoperative ileus (6.2% vs. 14.0%, p=0.031), and overall postoperative morbidity (18.5% vs. 33.8%, p=0.004). Patients in the laparoscopic group resumed oral intake and bowel function earlier, required analgesics for a shorter duration, and returned to normal activities sooner (all p<0.001).

Conclusion: Laparoscopic appendectomy was associated with lower postoperative morbidity, shorter hospitalization, and faster recovery than open appendectomy in patients with complicated acute appendicitis, without increasing intra-abdominal abscess, readmission, or reoperation rates.